Healthcare Provider Details

I. General information

NPI: 1295564425
Provider Name (Legal Business Name): RUBY PSYCHIATRIC SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LASALLE RD STE 300
WEST HARTFORD CT
06107-2311
US

IV. Provider business mailing address

225 BOSTON POST RD UNIT 38
EAST LYME CT
06333-7002
US

V. Phone/Fax

Practice location:
  • Phone: 860-494-5884
  • Fax:
Mailing address:
  • Phone: 860-494-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES GRANVILLE MARTIN
Title or Position: GENERAL COUNSEL
Credential: ESQ
Phone: 860-494-5884