Healthcare Provider Details

I. General information

NPI: 1184446445
Provider Name (Legal Business Name): JULIE RUGGIERO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 ISLIP AVE
ISLIP NY
11751-3028
US

IV. Provider business mailing address

4 JOSEPHINE LN
EAST ISLIP NY
11730-3104
US

V. Phone/Fax

Practice location:
  • Phone: 631-664-1582
  • Fax:
Mailing address:
  • Phone: 631-495-6673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123137
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: