Provider Demographics
NPI:1831543057
Name:RUIZ, MOLLY CROSSMAN (PHD)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:CROSSMAN
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:KRETCHMER
Other - Last Name:CROSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:575 VIRGINIA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 VIRGINIA RD STE 102
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2761
Practice Address - Country:US
Practice Address - Phone:978-440-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11383103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical