Provider Demographics
NPI:1104863372
Name:RUIZ, JENNIFER L (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:MCLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:310 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3510
Mailing Address - Country:US
Mailing Address - Phone:617-245-8900
Mailing Address - Fax:617-245-8900
Practice Address - Street 1:142 BERKELEY ST
Practice Address - Street 2:FENWAY COMMUNITY HEALTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5100
Practice Address - Country:US
Practice Address - Phone:617-927-6232
Practice Address - Fax:617-262-0872
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2279312084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry