Healthcare Provider Details

I. General information

NPI: 1669224499
Provider Name (Legal Business Name): TAYLOR RUGGIERI LCSW, LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

99 TEPEE TRL
CRANSTON RI
02921-2556
US

V. Phone/Fax

Practice location:
  • Phone: 401-462-9025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP01015
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW03614
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: