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General NPI Number Information
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NPI Number | 1306196456
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Entity Type | Individual
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Provider Name | RUBY KISH RN, LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 10175 FORTUNE PKWY 1106
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6746
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Country | US
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Telephone | 904-379-5928
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Fax |
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Provider Business Mailing Address
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Address Line | 9343 ILLINOIS ST
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City | JACKSONVILLE
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State | FL
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Zip | 32218-6023
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Country | US
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Telephone | 904-448-4402
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SW 10973
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License Number State | FL
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