=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003567876
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISABELLE G RUIZ DE LUZURIAGA LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2022
-----------------------------------------------------
Last Update Date | 07/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 68 HARRISON AVE # 60588774
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02111-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-443-8344
-----------------------------------------------------
Fax | 844-364-6593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 68 HARRISON AVE # 60588774
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02111-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-443-8344
-----------------------------------------------------
Fax | 844-364-6593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 227750
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW138705
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1120199
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------