MEDICARE: RUBY RIZO MARQUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1710720776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBY RIZO MARQUEZ

Provider Business Mailing Address
First Line	:	546 N HIGH ST APT 1
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-3152
Country	:	US
Telephone Number	:	914-409-7209
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GATEWAY PLZ STE 3B
Second Line	:
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-4681
Country	:	US
Telephone Number	:	914-305-6891
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	06/17/2024

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Directions to “ RUBY RIZO MARQUEZ ” Practice Location

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