Provider Demographics
NPI:1962083378
Name:RUIZ-VELEZ, MAYRA (CADC)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:RUIZ-VELEZ
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 N MICHIGAN AVE STE 3100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1962
Mailing Address - Country:US
Mailing Address - Phone:312-473-6463
Mailing Address - Fax:312-473-3693
Practice Address - Street 1:875 N MICHIGAN AVE STE 3100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1962
Practice Address - Country:US
Practice Address - Phone:312-473-6463
Practice Address - Fax:312-473-3693
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32168101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)