Provider Demographics
NPI:1376970988
Name:RUFFIN, CHRISTOPHER OMAR (MSW, ACSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:OMAR
Last Name:RUFFIN
Suffix:
Gender:M
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13627 SHERMAN WAY APT 107
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2803
Mailing Address - Country:US
Mailing Address - Phone:310-593-3468
Mailing Address - Fax:
Practice Address - Street 1:13627 SHERMAN WAY
Practice Address - Street 2:APT 107
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:310-593-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA894461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health