Provider Demographics
NPI:1053760579
Name:RUPPENICKER, MARGUERITE (PH D)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:
Last Name:RUPPENICKER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-0645
Mailing Address - Country:US
Mailing Address - Phone:860-388-9882
Mailing Address - Fax:860-388-9882
Practice Address - Street 1:49 SHERWOOD TER
Practice Address - Street 2:BASEMENT LEVEL
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2123
Practice Address - Country:US
Practice Address - Phone:860-388-9882
Practice Address - Fax:860-388-9882
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3193103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical