Provider Demographics
NPI:1750166690
Name:RENTERIA, RUBYTH (LCSW)
Entity type:Individual
Prefix:
First Name:RUBYTH
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RUBYTH
Other - Middle Name:RENTERIA
Other - Last Name:TIRADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2206 GARDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-4943
Mailing Address - Country:US
Mailing Address - Phone:903-245-1984
Mailing Address - Fax:
Practice Address - Street 1:2990 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-2149
Practice Address - Country:US
Practice Address - Phone:903-245-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical