Provider Demographics
NPI:1902030729
Name:RUPERTO, RICHARD ALAN
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:RUPERTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SE DIXIE HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3054
Mailing Address - Country:US
Mailing Address - Phone:772-223-9001
Mailing Address - Fax:
Practice Address - Street 1:500 SE DIXIE HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3054
Practice Address - Country:US
Practice Address - Phone:772-223-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral