Provider Demographics
NPI:1740739309
Name:RUIZ, MARIA CARISA (BCBA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CARISA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CAPCOM AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6517
Mailing Address - Country:US
Mailing Address - Phone:984-235-1058
Mailing Address - Fax:
Practice Address - Street 1:123 CAPCOM AVE STE 10
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6517
Practice Address - Country:US
Practice Address - Phone:984-235-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NC103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician