Healthcare Provider Details

I. General information

NPI: 1851172514
Provider Name (Legal Business Name): MIRIANA RUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SOUTH AVE STE 103
POUGHKEEPSIE NY
12601-4818
US

IV. Provider business mailing address

190 KRIPPLEBUSH RD
STONE RIDGE NY
12484-5806
US

V. Phone/Fax

Practice location:
  • Phone: 845-554-1365
  • Fax:
Mailing address:
  • Phone: 845-499-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: