Provider Demographics
NPI:1679820682
Name:RUGGIERO, MARC (LCSW)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:RUGGIERO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 STONEFLY WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-8632
Mailing Address - Country:US
Mailing Address - Phone:406-249-0091
Mailing Address - Fax:
Practice Address - Street 1:40 2ND ST E STE 236
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6114
Practice Address - Country:US
Practice Address - Phone:406-758-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2354-LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical