Provider Demographics
NPI:1962774612
Name:RUFFINI, COLLEEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:RUFFINI
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:PO BOX 6006
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-9006
Mailing Address - Country:US
Mailing Address - Phone:631-761-8325
Mailing Address - Fax:
Practice Address - Street 1:500 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2902
Practice Address - Country:US
Practice Address - Phone:631-761-8325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06974311041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool