Provider Demographics
NPI:1508537291
Name:RUGGERIO, ASHLEY MCMATH
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MCMATH
Last Name:RUGGERIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-4233
Mailing Address - Country:US
Mailing Address - Phone:757-814-8036
Mailing Address - Fax:
Practice Address - Street 1:348 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6349
Practice Address - Country:US
Practice Address - Phone:757-603-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010819101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional