Provider Demographics
NPI:1477751006
Name:SOMERVILLE, RUAN DAVINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RUAN
Middle Name:DAVINA
Last Name:SOMERVILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RUAN
Other - Middle Name:DAVINA
Other - Last Name:RAMNARINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:40 TENEYCK AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4016
Mailing Address - Country:US
Mailing Address - Phone:516-284-7994
Mailing Address - Fax:
Practice Address - Street 1:6200 BEACH CHANNEL DRIVE
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692
Practice Address - Country:US
Practice Address - Phone:718-945-7150
Practice Address - Fax:718-634-4838
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071513104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00990152Medicaid