Provider Demographics
NPI:1477568806
Name:MARGUERITE RUPPENICKER LLC
Entity type:Organization
Organization Name:MARGUERITE RUPPENICKER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGUERITE
Authorized Official - Middle Name:R A
Authorized Official - Last Name:RUPPENICKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-388-9882
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-0645
Mailing Address - Country:US
Mailing Address - Phone:860-388-9882
Mailing Address - Fax:860-388-9882
Practice Address - Street 1:49 SHERWOOD TER
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2123
Practice Address - Country:US
Practice Address - Phone:860-388-9882
Practice Address - Fax:860-388-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003193103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty