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General NPI Number Information
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NPI Number | 1679820682
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Entity Type | Individual
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Provider Name | MARC RUGGIERO L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 40 2ND ST E STE 236
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City | KALISPELL
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State | MT
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Zip | 59901-6114
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Country | US
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Telephone | 406-758-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 123 STONEFLY WAY
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City | COLUMBIA FALLS
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State | MT
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Zip | 59912-8632
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Country | US
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Telephone | 406-249-0091
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2354-LCSW
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License Number State | MT
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