| Doctor Name: | JILLIAN RUROEDE |
| NPI Number: | 1275786659 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 078852 |
| Business Practice Address: | 720 Front St Greenport, NY - 119441500 |
| Business Phone Number: | 6314771950 |
| Business Fax Number: | 6314772164 |
| Mailing Address: | 720 Front St, GREENPORT |
| State: | NY |
| Postal Code: | 119441500 |
| Phone Number: | 6314771950 |
| Fax Number: | 6314772164 |
| NPI Enumeration Date: | 10/29/2008 |
| NPI Last Update Date: | 09/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | 078852 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |