Provider Demographics
NPI:1922490705
Name:RUFFIN, TANIA DARNELL (CASAC-T)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:DARNELL
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 E 122ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2906
Mailing Address - Country:US
Mailing Address - Phone:212-360-7116
Mailing Address - Fax:212-289-5156
Practice Address - Street 1:177 E 122ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2906
Practice Address - Country:US
Practice Address - Phone:212-360-7116
Practice Address - Fax:212-289-5156
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31099101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)