Provider Demographics
NPI:1487834388
Name:RUBY, CHERYL COLLEEN
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:COLLEEN
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 1:290 PIONEER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2133
Mailing Address - Country:US
Mailing Address - Phone:831-459-6644
Mailing Address - Fax:831-459-0813
Practice Address - Street 1:115C CORAL ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2104
Practice Address - Country:US
Practice Address - Phone:831-459-6644
Practice Address - Fax:831-459-0813
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health