Provider Demographics
NPI:1427493816
Name:RUIZ, MARLENE BARBARA
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:BARBARA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 YACHT ST
Mailing Address - Street 2:SERVICE COORDINATOR OFFICE
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-2778
Mailing Address - Country:US
Mailing Address - Phone:203-455-6011
Mailing Address - Fax:203-367-1935
Practice Address - Street 1:199 YACHT ST
Practice Address - Street 2:SERVICE COORDINATOR OFFICE
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-2778
Practice Address - Country:US
Practice Address - Phone:203-455-6013
Practice Address - Fax:203-367-1935
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator