Provider Demographics
NPI:1164688503
Name:RUANE, GINA LUCIANA (LCSW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LUCIANA
Last Name:RUANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:LUCIANA
Other - Last Name:FIACCHINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYCHOTHERAPIST
Mailing Address - Street 1:1608 ASHTON CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3702
Mailing Address - Country:US
Mailing Address - Phone:773-806-9646
Mailing Address - Fax:
Practice Address - Street 1:460 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5176
Practice Address - Country:US
Practice Address - Phone:630-469-4699
Practice Address - Fax:630-469-4911
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0209251041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker