Provider Demographics
NPI:1104339647
Name:RUBY, CYNTHIA LUCILLE (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LUCILLE
Last Name:RUBY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:LUCILLE
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-3235
Mailing Address - Country:US
Mailing Address - Phone:410-766-9452
Mailing Address - Fax:410-766-9725
Practice Address - Street 1:7477 BALTIMORE ANNAPOLIS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3567
Practice Address - Country:US
Practice Address - Phone:410-766-9452
Practice Address - Fax:410-766-9725
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD052861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical