Healthcare Provider Details

I. General information

NPI: 1679820682
Provider Name (Legal Business Name): MARC RUGGIERO L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 2ND ST E STE 236
KALISPELL MT
59901-6114
US

IV. Provider business mailing address

123 STONEFLY WAY
COLUMBIA FALLS MT
59912-8632
US

V. Phone/Fax

Practice location:
  • Phone: 406-758-8118
  • Fax:
Mailing address:
  • Phone: 406-249-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2354-LCSW
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: