Healthcare Provider Details

I. General information

NPI: 1437609799
Provider Name (Legal Business Name): JOANNE RUGGIERO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 07/21/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 PARKER HILL ROAD EXTENSION
KILLINGWORTH CT
06419-2307
US

IV. Provider business mailing address

65 PARKER HILL RD. EXTENSION
KILLINGWORTH CT
06419
US

V. Phone/Fax

Practice location:
  • Phone: 203-937-2309
  • Fax:
Mailing address:
  • Phone: 203-937-2309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number009390
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: