Provider Demographics
NPI:1083728182
Name:RUGGIERO, DEBRA J (PHD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-2846
Mailing Address - Country:US
Mailing Address - Phone:406-777-3800
Mailing Address - Fax:406-777-0581
Practice Address - Street 1:715 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2846
Practice Address - Country:US
Practice Address - Phone:406-777-3800
Practice Address - Fax:406-777-0581
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT294103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0490607Medicaid
MT0490607Medicaid