Healthcare Provider Details

I. General information

NPI: 1992627517
Provider Name (Legal Business Name): DANIELLE NICOLE RUSCAK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 PADDOCK AVE
MERIDEN CT
06450-7044
US

IV. Provider business mailing address

211 POMEROY AVE APT 1410
MERIDEN CT
06450-1777
US

V. Phone/Fax

Practice location:
  • Phone: 203-630-5367
  • Fax: 203-634-7012
Mailing address:
  • Phone: 203-630-5367
  • Fax: 203-634-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number016923
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: