Healthcare Provider Details

I. General information

NPI: 1265900054
Provider Name (Legal Business Name): AMELIA RUGGIERI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH ST STE 2100
PHILADELPHIA PA
19103-6211
US

IV. Provider business mailing address

530 S 2ND ST APT 532
PHILADELPHIA PA
19147-2422
US

V. Phone/Fax

Practice location:
  • Phone: 215-545-1175
  • Fax:
Mailing address:
  • Phone: 240-462-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020093
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: