Provider Demographics
NPI:1366172256
Name:RAGUCKAS, AMBER GLEN
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:GLEN
Last Name:RAGUCKAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SAINT PETER ST UNIT 303
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4066
Mailing Address - Country:US
Mailing Address - Phone:484-241-8962
Mailing Address - Fax:
Practice Address - Street 1:800 CUMMINGS CTR STE 266T
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6172
Practice Address - Country:US
Practice Address - Phone:978-921-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health