Provider Demographics
NPI:1609012574
Name:VANWIJNEN, RUUD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUUD
Middle Name:
Last Name:VANWIJNEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NORTH AVE
Mailing Address - Street 2:2-A
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4823
Mailing Address - Country:US
Mailing Address - Phone:415-602-4081
Mailing Address - Fax:
Practice Address - Street 1:15 NORTH AVE
Practice Address - Street 2:2-A
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4823
Practice Address - Country:US
Practice Address - Phone:415-602-4081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical