Provider Demographics
NPI:1013638873
Name:GINA RUANE PROF CORP
Entity Type:Organization
Organization Name:GINA RUANE PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:LUCIANA
Authorized Official - Last Name:RUANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-815-9354
Mailing Address - Street 1:478 PENNSYLVANIA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4425
Mailing Address - Country:US
Mailing Address - Phone:630-474-0540
Mailing Address - Fax:
Practice Address - Street 1:478 PENNSYLVANIA AVE STE 202
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4425
Practice Address - Country:US
Practice Address - Phone:630-474-0540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GINA RUANE PROF CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty