Provider Demographics
NPI:1134697550
Name:RUIZ, CHRISTINE (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 MARGO DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6322
Mailing Address - Country:US
Mailing Address - Phone:856-982-4233
Mailing Address - Fax:
Practice Address - Street 1:27 S EAST BLVD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4608
Practice Address - Country:US
Practice Address - Phone:856-457-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-03
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06148100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0569577Medicaid
NJ14563895OtherCAQH