Provider Demographics
NPI:1558752253
Name:RUIZ, MARGARITA ELENA (LLMSW)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:ELENA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:MARGARITA
Other - Middle Name:ELENA
Other - Last Name:QUIROGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4255 KALAMAZOO AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3638
Mailing Address - Country:US
Mailing Address - Phone:616-455-0960
Mailing Address - Fax:616-455-7324
Practice Address - Street 1:4255 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3638
Practice Address - Country:US
Practice Address - Phone:616-455-0960
Practice Address - Fax:616-455-7324
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL139578104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker