Healthcare Provider Details

I. General information

NPI: 1538898812
Provider Name (Legal Business Name): GINA MARIE RUTIGLIANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 E MAIN ST STE LL5
SMITHTOWN NY
11787-2980
US

IV. Provider business mailing address

285 E MAIN ST STE LL5
SMITHTOWN NY
11787-2980
US

V. Phone/Fax

Practice location:
  • Phone: 631-724-0600
  • Fax:
Mailing address:
  • Phone: 631-724-0600
  • Fax: 631-724-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101028
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094483
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: