Provider Demographics
NPI:1871273094
Name:RUGGIERO, ALYSSA (MHC LP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:MHC LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SANDY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2123
Mailing Address - Country:US
Mailing Address - Phone:631-404-9606
Mailing Address - Fax:
Practice Address - Street 1:2233 NESCONSET HWY STE 201
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1000
Practice Address - Country:US
Practice Address - Phone:631-404-9606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP113348101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health