Provider Demographics
NPI:1356888952
Name:RUGGIRELLO, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RUGGIRELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1319
Mailing Address - Country:US
Mailing Address - Phone:610-597-9693
Mailing Address - Fax:
Practice Address - Street 1:111 FORREST AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2251
Practice Address - Country:US
Practice Address - Phone:610-597-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-21
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009097101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional