Provider Demographics
NPI:1811349632
Name:RUFFIN, PRINCESS (MA)
Entity type:Individual
Prefix:
First Name:PRINCESS
Middle Name:
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 GREAT HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3598
Mailing Address - Country:US
Mailing Address - Phone:954-296-9143
Mailing Address - Fax:
Practice Address - Street 1:2355 GREAT HARBOR DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3598
Practice Address - Country:US
Practice Address - Phone:954-296-9143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health