Provider Demographics
NPI:1275120990
Name:RUIZ, SAMANTHA IRIS (LMSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:IRIS
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E 105TH ST APT 15H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5163
Mailing Address - Country:US
Mailing Address - Phone:646-331-6480
Mailing Address - Fax:
Practice Address - Street 1:82-68 164TH ST, PAVILLION, SUITE P345
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-883-4712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110358104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker