Provider Demographics
NPI:1194892216
Name:RUOFF, MITCHELL K (PSYD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:K
Last Name:RUOFF
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:MITCH
Other - Middle Name:K
Other - Last Name:RUOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:5618 KIRKWOOD HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5004
Mailing Address - Country:US
Mailing Address - Phone:302-898-9229
Mailing Address - Fax:
Practice Address - Street 1:5618 KIRKWOOD HWY STE 2
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5004
Practice Address - Country:US
Practice Address - Phone:302-898-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000496103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE51-0035PHDOtherBLUE CROSS ID#
DE51-0035PHDOtherBLUE CROSS ID#
DE1000032466OtherDELAWARE PHYSICIANS CARE
DE2096948OtherCIGNA BEHVAIORAL HEALTH
DE253324OtherOPTIMUM CHOICE