Healthcare Provider Details

I. General information

NPI: 1497346548
Provider Name (Legal Business Name): MEGAN RUVOLO MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 E 550 S
LEBANON IN
46052-8136
US

IV. Provider business mailing address

3875 E 550 S
LEBANON IN
46052-8136
US

V. Phone/Fax

Practice location:
  • Phone: 740-221-2042
  • Fax:
Mailing address:
  • Phone: 740-221-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34009126A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: