Provider Demographics
NPI:1962623272
Name:HUMPHREY, RUAN C (MA)
Entity type:Individual
Prefix:
First Name:RUAN
Middle Name:C
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021-A EAST ROBINSON STREET
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2004
Mailing Address - Country:US
Mailing Address - Phone:407-423-3327
Mailing Address - Fax:407-843-1860
Practice Address - Street 1:1021-A EAST ROBINSON STREET
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2004
Practice Address - Country:US
Practice Address - Phone:407-423-3327
Practice Address - Fax:407-843-1860
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health