Provider Demographics
NPI:1437142155
Name:RUEGG, ELIZABETH (LCSW, BCD, CAP, CT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:RUEGG
Suffix:
Gender:F
Credentials:LCSW, BCD, CAP, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9222 REGENCY PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-5023
Mailing Address - Country:US
Mailing Address - Phone:727-967-3320
Mailing Address - Fax:727-841-0086
Practice Address - Street 1:9222 REGENCY PARK BLVD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-5023
Practice Address - Country:US
Practice Address - Phone:727-967-3320
Practice Address - Fax:727-841-0086
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-28
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 3044101YA0400X
FLLCSW 47321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8105ZMedicare UPIN