Provider Demographics
NPI:1063889566
Name:HARKRUIZ, SYDNEY MICHELE (LCSW)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MICHELE
Last Name:HARKRUIZ
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:MICHELE
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1702
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95741-1702
Mailing Address - Country:US
Mailing Address - Phone:916-261-6054
Mailing Address - Fax:
Practice Address - Street 1:5007 KENNETH AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-5329
Practice Address - Country:US
Practice Address - Phone:916-261-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X, 1041C0700X
CAASW90132104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program