Provider Demographics
NPI:1851901920
Name:RUANE, SEAN X
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:RUANE
Suffix:X
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2700
Mailing Address - Country:US
Mailing Address - Phone:505-692-4473
Mailing Address - Fax:
Practice Address - Street 1:1911 5TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-8750
Practice Address - Country:US
Practice Address - Phone:505-955-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35588519Medicaid
NM66330050Medicaid