Provider Demographics
NPI:1205079944
Name:RUGGIERO, SANDRA (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
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 1:47 WINNECOMAC CIR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4608
Mailing Address - Country:US
Mailing Address - Phone:516-647-8708
Mailing Address - Fax:631-385-5956
Practice Address - Street 1:47 WINNECOMAC CIR
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-4608
Practice Address - Country:US
Practice Address - Phone:516-647-8708
Practice Address - Fax:631-385-5956
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048870-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN21771Medicare PIN