Healthcare Provider Details

I. General information

NPI: 1508211210
Provider Name (Legal Business Name): RICHARD RUGGIERO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2016
Last Update Date: 05/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 W CHESTNUT ST STE. 101
BROCKTON MA
02301-7501
US

IV. Provider business mailing address

199 BRISTOL ST
SPRINGFIELD MA
01109-2837
US

V. Phone/Fax

Practice location:
  • Phone: 203-530-1485
  • Fax:
Mailing address:
  • Phone: 203-530-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: