Provider Demographics
NPI:1336317742
Name:RUIZ FACTOR, EDIE (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:MRS
First Name:EDIE
Middle Name:
Last Name:RUIZ FACTOR
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3256
Mailing Address - Country:US
Mailing Address - Phone:305-854-2311
Mailing Address - Fax:305-854-2314
Practice Address - Street 1:101 MAJORCA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4508
Practice Address - Country:US
Practice Address - Phone:305-854-2311
Practice Address - Fax:305-854-2314
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health