| Well Child Lcsw Pllc | |
|
92 Broad St Fl 2 Glens Falls NY 12801-4383 | |
| (151) 822-2589 | |
| Not Available |
| Full Name | Well Child Lcsw Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 92 Broad St Fl 2, Glens Falls, New York |
| Authorized Official Name and Position | Tia M Ruggiero (MANAGING MEMBER) |
| Authorized Official Contact | 5184804002 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Well Child Lcsw Pllc 92 Broad St Fl 2 Glens Falls NY 12801-4383 Ph: (151) 822-2589 | Well Child Lcsw Pllc 92 Broad St Fl 2 Glens Falls NY 12801-4383 Ph: (151) 822-2589 |
| NPI Number | 1689303869 |
|---|---|
| Provider Enumeration Date | 06/06/2022 |
| Last Update Date | 06/06/2022 |
| Certification Date | 06/06/2022 |
| Medicare PECOS PAC ID | 9234510090 |
|---|---|
| Medicare Enrollment ID | O20220726000427 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689303869 | NPI | - | NPPES |
| 1598149395 | Other | NY | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tia M. Ruggiero |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598149395 PECOS PAC ID: 5092127894 Enrollment ID: I20201221001380 |
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