Provider Demographics
NPI:1154542140
Name:RUGGIERO, SELBE POTTER (LCSW)
Entity type:Individual
Prefix:
First Name:SELBE
Middle Name:POTTER
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 NARROW ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-6016
Mailing Address - Country:US
Mailing Address - Phone:203-307-3030
Mailing Address - Fax:203-255-7486
Practice Address - Street 1:18 NARROW ROCKS RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-6016
Practice Address - Country:US
Practice Address - Phone:203-434-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0026521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical