Provider Demographics
NPI:1720485816
Name:RUIZ, YVETTE IRENE (MED,LPC)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:IRENE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MED,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W LIBERTY ST # 136
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2798
Mailing Address - Country:US
Mailing Address - Phone:717-690-1092
Mailing Address - Fax:
Practice Address - Street 1:313 W LIBERTY ST # 136
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2798
Practice Address - Country:US
Practice Address - Phone:717-690-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional