Provider Demographics
NPI:1588296438
Name:RUIZ, VIVIANA MARCEL (PASTORAL COUNSELOR)
Entity type:Individual
Prefix:
First Name:VIVIANA
Middle Name:MARCEL
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PASTORAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25851 KEYSER RD
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3133
Mailing Address - Country:US
Mailing Address - Phone:315-222-4305
Mailing Address - Fax:
Practice Address - Street 1:25851 KEYSER RD
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-3133
Practice Address - Country:US
Practice Address - Phone:315-222-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral