Healthcare Provider Details

I. General information

NPI: 1689959462
Provider Name (Legal Business Name): MICHAEL RUGGIERO LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WELLINGTON PLACE
ABERDEEN NJ
07747
US

IV. Provider business mailing address

104 WELLINGTON PLACE
ABERDEEN NJ
07747
US

V. Phone/Fax

Practice location:
  • Phone: 908-601-7871
  • Fax:
Mailing address:
  • Phone: 908-601-7871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00407900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: