Provider Demographics
NPI:1972822146
Name:RUIZ, ALICIA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ANN
Last Name:RUIZ
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 1:930 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4209
Mailing Address - Country:US
Mailing Address - Phone:718-477-5215
Mailing Address - Fax:
Practice Address - Street 1:930 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4209
Practice Address - Country:US
Practice Address - Phone:718-477-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079791104100000X
NY08143211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker