Provider Demographics
NPI:1992880256
Name:SALAZAR, RUBY MOYE (LCSW, BCD)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:MOYE
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1508
Mailing Address - Country:US
Mailing Address - Phone:570-586-3587
Mailing Address - Fax:570-586-0337
Practice Address - Street 1:500 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1508
Practice Address - Country:US
Practice Address - Phone:570-586-3587
Practice Address - Fax:570-586-0337
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-004836-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA616812Medicare ID - Type UnspecifiedMENTAL HEALTH