Healthcare Provider Details

I. General information

NPI: 1477128098
Provider Name (Legal Business Name): JULIA C RUGGIERO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BEAVERBROOK CT
CHESHIRE CT
06410-4301
US

IV. Provider business mailing address

57 BEAVERBROOK CT
CHESHIRE CT
06410-4301
US

V. Phone/Fax

Practice location:
  • Phone: 513-760-6524
  • Fax:
Mailing address:
  • Phone: 203-859-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number013272
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5287
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: