Provider Demographics
NPI:1417426628
Name:RUIZ, VIVIANA (MSW)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 W WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3042
Mailing Address - Country:US
Mailing Address - Phone:773-907-8262
Mailing Address - Fax:
Practice Address - Street 1:3605 W FILLMORE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-4310
Practice Address - Country:US
Practice Address - Phone:773-588-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health