Healthcare Provider Details

I. General information

NPI: 1619154838
Provider Name (Legal Business Name): CLARISSA JOANNE RUIZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S DE LACEY AVE STE 110
PASADENA CA
91105-2074
US

IV. Provider business mailing address

620 E SANTA ANITA AVE APT P
BURBANK CA
91501-2941
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7100
  • Fax:
Mailing address:
  • Phone: 805-878-5989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW70999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: