Provider Demographics
NPI:1689303869
Name:WELL CHILD LCSW PLLC
Entity Type:Organization
Organization Name:WELL CHILD LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUGGIERO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:518-480-4002
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:151-822-2589
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:151-822-2589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1598149395OtherNPPES