| Doctor Name: | KELLYANNE RUGENSTEIN |
| NPI Number: | 1447363015 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 071634-1 |
| Business Practice Address: | 220 N Ballston Ave Scotia, NY - 12302 |
| Business Phone Number: | 5183743514 |
| Business Fax Number: | 5183749193 |
| Mailing Address: | 220 N Ballston Ave, SCOTIA |
| State: | NY |
| Postal Code: | 12302 |
| Phone Number: | 5183743514 |
| Fax Number: | 5183749193 |
| NPI Enumeration Date: | 08/16/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 071634-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |