Doctor Name: | SELBE POTTER RUGGIERO |
NPI Number: | 1154542140 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 002652 |
Business Practice Address: | 49 John St Southport, CT - 068901436 |
Business Phone Number: | 2033073030 |
Business Fax Number: | 2032557486 |
Mailing Address: | 18 Narrow Rocks Rd, WESTPORT |
State: | CT |
Postal Code: | 068806016 |
Phone Number: | 2033073030 |
Fax Number: | 2032557486 |
NPI Enumeration Date: | 05/01/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 002652 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |