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NPI 1073035762

NPI 1073035762 : JANA M RUIZ LICSW : SALEM, NH

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General NPI Number Information
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    NPI Number           |    1073035762
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    Entity Type          |    Individual 
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    Provider Name        |    JANA M RUIZ LICSW
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    07/13/2017
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    Last Update Date     |    06/16/2018
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Provider Practice Location Address
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    Address Line         |    87 STILES RD STE 106 
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    City                 |    SALEM
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    State                |    NH
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    Zip                  |    03079-2899
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    Country              |    US
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    Telephone            |    603-893-7707
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    3 BEAU ACRES 
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    City                 |    CANDIA
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    State                |    NH
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    Zip                  |    03034-1700
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    1041C0700X
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    Taxonomy Name        |    Clinical Social Worker
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    License Number       |    
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    License Number State |    
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