Provider Demographics
NPI:1497216295
Name:RUFFIN, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 CASTLETON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1818
Mailing Address - Country:US
Mailing Address - Phone:718-570-2081
Mailing Address - Fax:718-273-5159
Practice Address - Street 1:690 CASTLETON AVE STE 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1818
Practice Address - Country:US
Practice Address - Phone:718-570-2081
Practice Address - Fax:718-273-5159
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor