Provider Demographics
NPI:1336749340
Name:RUIZ, KEVIN (LMSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:785 DEAN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3100
Mailing Address - Country:US
Mailing Address - Phone:678-693-0136
Mailing Address - Fax:
Practice Address - Street 1:850 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5230
Practice Address - Country:US
Practice Address - Phone:646-797-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1091551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical