Healthcare Provider Details

I. General information

NPI: 1598949869
Provider Name (Legal Business Name): KATHERINE MARIE RUGGIERO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 RIVERSIDE AVE
BURLINGTON VT
05401-1601
US

IV. Provider business mailing address

617 RIVERSIDE AVE
BURLINGTON VT
05401-1601
US

V. Phone/Fax

Practice location:
  • Phone: 802-264-8189
  • Fax:
Mailing address:
  • Phone: 802-264-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0055532
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016262
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: