Healthcare Provider Details

I. General information

NPI: 1659010650
Provider Name (Legal Business Name): AMY RUZIC MA, BC-DMT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHETWYND DR
BRYN MAWR PA
19010-1453
US

IV. Provider business mailing address

530 HAMPSHIRE RD
DREXEL HILL PA
19026-1306
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-1144
  • Fax:
Mailing address:
  • Phone: 630-240-9456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License NumberBC-DMT-1053
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006037
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: