Provider Demographics
NPI:1760755755
Name:RUBY, RICHARD JAMES III (CADC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JAMES
Last Name:RUBY
Suffix:III
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20468 COASTAL HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-8030
Mailing Address - Country:US
Mailing Address - Phone:302-227-1320
Mailing Address - Fax:
Practice Address - Street 1:20468 COASTAL HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-8030
Practice Address - Country:US
Practice Address - Phone:302-227-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA7748101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1659652980Medicaid