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General NPI Number Information
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NPI Number | 1588711949
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Entity Type | Individual
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Provider Name | SUSAN DIANE RUGGIERO M.ED., LMHC, LCDCS
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 163 WATERMAN ST
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City | PROVIDENCE
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State | RI
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Zip | 02906-3109
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Country | US
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Telephone | 401-331-9800
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Fax | 401-490-4047
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Provider Business Mailing Address
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Address Line | 5 CAMBRIDGE CIR
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City | SMITHFIELD
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State | RI
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Zip | 02917-2564
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Country | US
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Telephone | 401-232-9004
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Fax | 401-231-0770
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MHC00154
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License Number State | RI
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