Healthcare Provider Details

I. General information

NPI: 1013567122
Provider Name (Legal Business Name): ALICIA RUIZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N VILLAGE AVE STE 1B
ROCKVILLE CENTRE NY
11570-4610
US

IV. Provider business mailing address

97 CEDARHURST AVE STE 3
CEDARHURST NY
11516-2140
US

V. Phone/Fax

Practice location:
  • Phone: 516-350-8564
  • Fax:
Mailing address:
  • Phone: 516-350-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009760-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: