Provider Demographics
NPI:1184738379
Name:RUIZ, ILEANA (LCSW)
Entity type:Individual
Prefix:MS
First Name:ILEANA
Middle Name:
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 1:85 NEW MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-1548
Mailing Address - Country:US
Mailing Address - Phone:845-709-0239
Mailing Address - Fax:845-429-1347
Practice Address - Street 1:50 SANITORIUM RD BUILDING F - DEPT OF MENTAL HEALTH
Practice Address - Street 2:ROCKLAND COUNTY SUMMIT PARK HOSPITAL
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3555
Practice Address - Country:US
Practice Address - Phone:845-364-2275
Practice Address - Fax:845-364-3363
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046307-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W02641OtherCOUNTY OF ROCKLAND
NYNH14202641OtherMEDICARE NH14202641 LINKED TO GROUP PTAN W02641
NH14202641Medicare PIN
W02641OtherCOUNTY OF ROCKLAND
NYNH1421Medicare ID - Type Unspecified