Healthcare Provider Details

I. General information

NPI: 1659959260
Provider Name (Legal Business Name): CHELSEA ADAIRE RUGGIERO MSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3648 MARPAT DR
ABINGDON MD
21009-2044
US

IV. Provider business mailing address

3648 MARPAT DR
ABINGDON MD
21009-2044
US

V. Phone/Fax

Practice location:
  • Phone: 443-802-2547
  • Fax:
Mailing address:
  • Phone: 443-802-2547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number24249
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: