Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | NY |
NPI | 1083220826 |
---|---|
Provider Name | Tina Ruggiero |
First Address | Manorville, NY 11949-2613 |
Second Address | Manorville, NY 11949-2613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2020 |
Last Update Date | 17/09/2020 |