Provider Demographics
NPI:1013567122
Name:RUIZ, ALICIA (LMHC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CEDARHURST AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2140
Mailing Address - Country:US
Mailing Address - Phone:516-350-8564
Mailing Address - Fax:
Practice Address - Street 1:45 N VILLAGE AVE STE 1B
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4610
Practice Address - Country:US
Practice Address - Phone:516-350-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009760-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health