Healthcare Provider Details

I. General information

NPI: 1134578818
Provider Name (Legal Business Name): KATHYLIN RUANO LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TWINBROOK PKWY
ROCKVILLE MD
20851-1201
US

IV. Provider business mailing address

13105 BRIARCLIFF TER APT 1113
GERMANTOWN MD
20874-2682
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-0656
  • Fax:
Mailing address:
  • Phone: 301-922-8435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21788
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: