Provider Demographics
NPI:1356655237
Name:RUBY, MONICA ELISE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ELISE
Last Name:RUBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 PLUM LN STE B
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-0109
Mailing Address - Country:US
Mailing Address - Phone:909-447-6574
Mailing Address - Fax:909-363-9202
Practice Address - Street 1:1740 PLUM LN STE B
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-0109
Practice Address - Country:US
Practice Address - Phone:909-447-6574
Practice Address - Fax:909-363-9202
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1092009193103K00000X
CA206341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst