Provider Demographics
NPI:1164641148
Name:RUIZ, MA JOSEPHINE (MA ATR-BC LCPC)
Entity Type:Individual
Prefix:MS
First Name:MA JOSEPHINE
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MA ATR-BC LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4970 N MARINE DR
Mailing Address - Street 2:APT # 126
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3968
Mailing Address - Country:US
Mailing Address - Phone:312-804-2241
Mailing Address - Fax:
Practice Address - Street 1:3533 S ARCHER AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1135
Practice Address - Country:US
Practice Address - Phone:773-847-4417
Practice Address - Fax:773-847-4942
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional