Provider Demographics
NPI:1346501038
Name:RUIZ, DEVORATH GRACE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEVORATH
Middle Name:GRACE
Last Name:RUIZ
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 1:75 FRANCIS ST
Mailing Address - Street 2:DEPARTMENT OF CARE COORDINATION
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-525-9777
Mailing Address - Fax:617-732-6468
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:DEPARTMENT OF CARE COORDINATION
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-525-9777
Practice Address - Fax:617-732-6468
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2167491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical