Provider Demographics
NPI:1598103293
Name:RUIZ, ELISE MILAGROS (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:MILAGROS
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:MILAGROS
Other - Last Name:NUNEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:33 COURT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2211
Mailing Address - Country:US
Mailing Address - Phone:203-519-6900
Mailing Address - Fax:888-980-6983
Practice Address - Street 1:33 COURT ST STE 2
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2211
Practice Address - Country:US
Practice Address - Phone:203-519-6900
Practice Address - Fax:888-980-6983
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18268101YP2500X
CT3253101YP2500X
SC8661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008081040Medicaid
CT008074680Medicaid
CT3253OtherLPC