Healthcare Provider Details

I. General information

NPI: 1588890305
Provider Name (Legal Business Name): LINDA RUGGIERO-MARCINIAK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 BEAVERBROOK RD
LINCOLN PARK NJ
07035-1440
US

IV. Provider business mailing address

63 BEAVERBROOK RD
LINCOLN PARK NJ
07035-1440
US

V. Phone/Fax

Practice location:
  • Phone: 973-696-0800
  • Fax: 973-305-8078
Mailing address:
  • Phone: 973-696-0800
  • Fax: 973-305-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00591700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: