Provider Demographics
NPI:1942833215
Name:TRIGONIS-QUESADA, RUTH VALERIA (LCSW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:VALERIA
Last Name:TRIGONIS-QUESADA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8453
Mailing Address - Country:US
Mailing Address - Phone:850-291-2002
Mailing Address - Fax:
Practice Address - Street 1:69 BAY BRIDGE DR STE H
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4468
Practice Address - Country:US
Practice Address - Phone:850-291-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW170341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical