Provider Demographics
NPI:1770141228
Name:RUFFIN, CEDRINA (PHD, LCSW-S)
Entity type:Individual
Prefix:
First Name:CEDRINA
Middle Name:
Last Name:RUFFIN
Suffix:
Gender:
Credentials:PHD, LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 MAYWOOD RUN CT
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-7141
Mailing Address - Country:US
Mailing Address - Phone:281-736-0671
Mailing Address - Fax:
Practice Address - Street 1:4220 CARTWRIGHT RD STE 1105
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5316
Practice Address - Country:US
Practice Address - Phone:832-226-7029
Practice Address - Fax:832-610-3976
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196871101Medicaid