Provider Demographics
NPI:1518988237
Name:RUFFENNACH, MARY C (CAGS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:RUFFENNACH
Suffix:
Gender:F
Credentials:CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MAXWELL DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-2058
Mailing Address - Country:US
Mailing Address - Phone:412-882-3730
Mailing Address - Fax:
Practice Address - Street 1:4701 BAPTIST RD
Practice Address - Street 2:MANOR BUILDING SUITE 208
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-1117
Practice Address - Country:US
Practice Address - Phone:412-882-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006458L103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5205678Medicare UPIN
PA110250Medicare UPIN
PA257776Medicare UPIN
PA553523Medicare UPIN
PA516769Medicare UPIN
PA785125Medicare UPIN