Provider Demographics
NPI:1114994753
Name:RUUD, CHARISSA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARISSA
Middle Name:A
Last Name:RUUD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 CAMINO DEL RIO S STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3756
Mailing Address - Country:US
Mailing Address - Phone:619-881-0377
Mailing Address - Fax:
Practice Address - Street 1:2535 CAMINO DEL RIO S STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3756
Practice Address - Country:US
Practice Address - Phone:619-881-0377
Practice Address - Fax:858-777-9676
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical