Healthcare Provider Details

I. General information

NPI: 1659497519
Provider Name (Legal Business Name): CARRIE ELIZABETH RUGGIERI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 BROADWAY
PROVIDENCE RI
02909-1416
US

IV. Provider business mailing address

378 BROADWAY
PROVIDENCE RI
02909-1416
US

V. Phone/Fax

Practice location:
  • Phone: 401-454-4040
  • Fax:
Mailing address:
  • Phone: 401-454-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00055
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: