Healthcare Provider Details

I. General information

NPI: 1821535071
Provider Name (Legal Business Name): KELSEY RUGGIERO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11254 58TH ST N
PINELLAS PARK FL
33782-2213
US

IV. Provider business mailing address

11254 58TH ST N
PINELLAS PARK FL
33782-2213
US

V. Phone/Fax

Practice location:
  • Phone: 727-545-6477
  • Fax:
Mailing address:
  • Phone: 727-545-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: