Healthcare Provider Details

I. General information

NPI: 1821575929
Provider Name (Legal Business Name): MARIA D. RUIZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA RUIZ APRN

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 02/15/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MAIN STREET COMMUNITY MENTAL HEALTH AFFILIATES
NEW BRITAIN CT
06051
US

IV. Provider business mailing address

233 MAIN ST
NEW BRITAIN CT
06051-4204
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-8192
  • Fax:
Mailing address:
  • Phone: 860-224-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number007529
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: