Healthcare Provider Details

I. General information

NPI: 1659984938
Provider Name (Legal Business Name): FRANCENE STACEE RUGENDORF LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 CAMBRIDGE DR
RED HOOK NY
12571-1611
US

IV. Provider business mailing address

228 WEST 71ST ST. 6A
NEW YORK NY
10023
US

V. Phone/Fax

Practice location:
  • Phone: 203-571-8171
  • Fax:
Mailing address:
  • Phone: 203-571-8171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109885
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109885-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: