Provider Demographics
NPI:1144383902
Name:RUGULEISKI, CYNTHIA DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DENISE
Last Name:RUGULEISKI
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 1:1315 HIGHWAY 2 STE 4
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2724
Mailing Address - Country:US
Mailing Address - Phone:406-546-9818
Mailing Address - Fax:208-625-2062
Practice Address - Street 1:1315 HIGHWAY 2 STE 4
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2724
Practice Address - Country:US
Practice Address - Phone:208-261-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-311421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806106400Medicaid
ID806064200Medicaid