Healthcare Provider Details

I. General information

NPI: 1255621439
Provider Name (Legal Business Name): JACQUELINE A RUGGIERI MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W 9TH ST
CHESTER PA
19013-2040
US

IV. Provider business mailing address

2611 CYNWYD AVE
BROOMALL PA
19008-1912
US

V. Phone/Fax

Practice location:
  • Phone: 610-497-7237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: