Provider Demographics
NPI:1881367035
Name:RUGGIERO, AMY LYNN MCDEVITT (LSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN MCDEVITT
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3318
Mailing Address - Country:US
Mailing Address - Phone:610-787-2882
Mailing Address - Fax:
Practice Address - Street 1:1045 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3318
Practice Address - Country:US
Practice Address - Phone:610-787-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138345104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker