Healthcare Provider Details

I. General information

NPI: 1194892216
Provider Name (Legal Business Name): MITCHELL K RUOFF PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MITCH K RUOFF PSY.D.

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/06/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5618 KIRKWOOD HWY STE 2
WILMINGTON DE
19808-5004
US

IV. Provider business mailing address

5618 KIRKWOOD HWY STE 2
WILMINGTON DE
19808-5004
US

V. Phone/Fax

Practice location:
  • Phone: 302-898-9229
  • Fax:
Mailing address:
  • Phone: 302-898-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberB1-0000496
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: