Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 12380 | MA |
Y | 1041C0700X | Clinical Social Worker | 1025562-1 | MA |
NPI | 1003267568 |
---|---|
Provider Name | Ms. Felice De Ruggiero |
First Address | Tewksbury, MA 01876-1950 |
Second Address | Tewksbury, MA 01876-1950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2016 |
Last Update Date | 27/06/2016 |