Provider Demographics
NPI:1336453414
Name:COLON RUIZ, MILDRED (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:
Last Name:COLON 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 1:20 WENDELL ST APT 19C
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-1250
Mailing Address - Country:US
Mailing Address - Phone:516-455-3314
Mailing Address - Fax:
Practice Address - Street 1:20 WENDELL ST APT 19C
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-1250
Practice Address - Country:US
Practice Address - Phone:516-455-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0336061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical