Provider Demographics
NPI:1235473521
Name:RUELAS, IRIS L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:L
Last Name:RUELAS
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 1:8 KNIGHT CT
Mailing Address - Street 2:
Mailing Address - City:SPARKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10976-1054
Mailing Address - Country:US
Mailing Address - Phone:845-598-6578
Mailing Address - Fax:
Practice Address - Street 1:8 KNIGHT CT
Practice Address - Street 2:
Practice Address - City:SPARKILL
Practice Address - State:NY
Practice Address - Zip Code:10976-1054
Practice Address - Country:US
Practice Address - Phone:845-598-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730595691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical