Individual
BLANCA RUTH NICASSIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AMFT
Contact information
Practice address
14677 MERRILL AVE, FONTANA, CA 92335
(951) 643-2340
Mailing address
9825 MAGNOLIA AVE STE B, RIVERSIDE, CA 92503-3565
(951) 509-2499
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
106568
CA
101YM0800X
Mental Health Counselor
APCC6302
CA
Other
Enumeration date
01/29/2019
Last updated
09/25/2023
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