Provider Demographics
NPI:1104160241
Name:RUFFALO, MARK LOUIS JR (MSW, ACSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LOUIS
Last Name:RUFFALO
Suffix:JR
Gender:M
Credentials:MSW, ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10335 CROSS CREEK BLVD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2795
Mailing Address - Country:US
Mailing Address - Phone:727-266-0270
Mailing Address - Fax:
Practice Address - Street 1:10335 CROSS CREEK BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2795
Practice Address - Country:US
Practice Address - Phone:727-266-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X
NCC0095041041C0700X
FLSW128571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical