Provider Demographics
NPI:1760836035
Name:LEWIS, RUBY
Entity Type:Individual
Prefix:MS
First Name:RUBY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3410
Mailing Address - Country:US
Mailing Address - Phone:626-239-3060
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:126 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3410
Practice Address - Country:US
Practice Address - Phone:626-239-3060
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health