Provider Demographics
NPI:1851603781
Name:RUIZ, ANDREA (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:2205 A. SOUTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005
Mailing Address - Country:US
Mailing Address - Phone:575-386-4184
Mailing Address - Fax:575-526-1568
Practice Address - Street 1:2205 A. SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005
Practice Address - Country:US
Practice Address - Phone:575-386-4184
Practice Address - Fax:575-526-1568
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-073791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical