Provider Demographics
NPI:1871593806
Name:RUGGIERI, PAMELA JOY (PHD HSPP)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JOY
Last Name:RUGGIERI
Suffix:
Gender:F
Credentials:PHD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8400 LOUISIANA STREET
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6385
Mailing Address - Country:US
Mailing Address - Phone:219-757-1928
Mailing Address - Fax:219-757-1950
Practice Address - Street 1:290 E 90TH DRIVE
Practice Address - Street 2:STE A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8101
Practice Address - Country:US
Practice Address - Phone:219-736-9115
Practice Address - Fax:219-736-9131
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040010A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN409180FMedicare ID - Type Unspecified