Provider Demographics
NPI:1588711949
Name:RUGGIERO, SUSAN DIANE (MED, LMHC, LCDCS)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DIANE
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:MED, LMHC, LCDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CAMBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2564
Mailing Address - Country:US
Mailing Address - Phone:401-232-9004
Mailing Address - Fax:401-231-0770
Practice Address - Street 1:163 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3109
Practice Address - Country:US
Practice Address - Phone:401-331-9800
Practice Address - Fax:401-490-4047
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health