Provider Demographics
NPI:1295564425
Name:RUBY PSYCHIATRIC SERVICES, PLLC
Entity type:Organization
Organization Name:RUBY PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GRANVILLE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:860-494-5884
Mailing Address - Street 1:225 BOSTON POST RD UNIT 38
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-7002
Mailing Address - Country:US
Mailing Address - Phone:860-494-5884
Mailing Address - Fax:
Practice Address - Street 1:17 SALEM HOLLOW LN
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:CT
Practice Address - Zip Code:06420-4046
Practice Address - Country:US
Practice Address - Phone:860-494-5884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-27
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty