Provider Demographics
NPI:1033643093
Name:RUIZ, MIRIAM JEANNETTE (LCSW, CADC II)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:JEANNETTE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LCSW, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3109
Mailing Address - Country:US
Mailing Address - Phone:310-279-3242
Mailing Address - Fax:
Practice Address - Street 1:12110 SLAUSON AVE STE 16
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-8656
Practice Address - Country:US
Practice Address - Phone:323-524-9347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1176731041C0700X
CAA059510321101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty