Provider Demographics
NPI:1780256792
Name:RUIZ, MARIA CONNIE
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CONNIE
Last Name:RUIZ
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 1:39310 N MELBOURNE CT
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60083-3026
Mailing Address - Country:US
Mailing Address - Phone:847-505-3413
Mailing Address - Fax:
Practice Address - Street 1:39310 N MELBOURNE CT
Practice Address - Street 2:
Practice Address - City:BEACH PARK
Practice Address - State:IL
Practice Address - Zip Code:60083-3026
Practice Address - Country:US
Practice Address - Phone:847-505-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health