MEDICARE: JEANNINA RUIZ LPC, LMHC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	37AC00340400	NJ
2	101YM0800X	Mental Health Counselor	MH21762	FL
3	103TC1900X	Counseling Psychologist	37AC00340400	NJ
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1366941874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNINA RUIZ LPC, LMHC, NCC

Provider Business Mailing Address
First Line	:	9580 BARLETTA WINDS PT
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-9706
Country	:	US
Telephone Number	:	973-405-3897
Fax Number	:

Provider Business Practice Location Address
First Line	:	9580 BARLETTA WINDS PT
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-9706
Country	:	US
Telephone Number	:	973-405-3897
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2018
Last Update Date	:	04/18/2024

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