Healthcare Provider Details

I. General information

NPI: 1275073827
Provider Name (Legal Business Name): JOHN RUGGIERO LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 MERRIMACK ST # 80
HAVERHILL MA
01830-6245
US

IV. Provider business mailing address

76 MERRIMACK ST # 80
HAVERHILL MA
01830-6245
US

V. Phone/Fax

Practice location:
  • Phone: 978-912-9067
  • Fax:
Mailing address:
  • Phone: 978-912-9067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115209
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: