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Organization
EASTERN DOOR LICENSED CLINICAL SOCIAL WORK, PC
Active
Organization
EASTERN DOOR LICENSED CLINICAL SOCIAL WORK, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLYANNE RUGENSTEIN LCSW, PHD (OWNER)
(518) 252-7073
Entity
Organization
Contact information
Practice address
620 WASHINGTON AVE, RENSSELAER, NY 12144-1300
(518) 252-7073
(518) 252-7073
Mailing address
620 WASHINGTON AVE, RENSSELAER, NY 12144-1300
(518) 252-7073
(518) 252-7073
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03068682
—
NY
Enumeration date
11/10/2016
Last updated
03/26/2025
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