Provider Demographics
NPI:1871224360
Name:RUIZ OLMEDA, CHRISTY MARIE
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:MARIE
Last Name:RUIZ OLMEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:MARIE
Other - Last Name:RUIZ OLMEDA, MS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC
Mailing Address - Street 1:617 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-5239
Mailing Address - Country:US
Mailing Address - Phone:603-288-2872
Mailing Address - Fax:
Practice Address - Street 1:6 MANOR PKWY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2841
Practice Address - Country:US
Practice Address - Phone:603-458-6925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health