Provider Demographics
NPI:1477660033
Name:RUGGERI, MARIANNE THERESE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:THERESE
Last Name:RUGGERI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 JONES ROAD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540
Mailing Address - Country:US
Mailing Address - Phone:508-540-4542
Mailing Address - Fax:508-548-0981
Practice Address - Street 1:184 JONES ROAD
Practice Address - Street 2:SUITE 1B
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-540-4542
Practice Address - Fax:508-548-0981
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4697103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04509Medicare ID - Type Unspecified