Provider Demographics
NPI:1598149395
Name:RUGGIERO, TIA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:MARIE
Last Name:RUGGIERO
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 1:92 BROAD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4383
Mailing Address - Country:US
Mailing Address - Phone:518-480-4002
Mailing Address - Fax:
Practice Address - Street 1:92 BROAD ST FL 2
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4383
Practice Address - Country:US
Practice Address - Phone:518-480-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP982301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY88-2382098OtherIRS