Provider Demographics
NPI:1992999296
Name:KELLY, RUTH LYNNE (LMSW)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:LYNNE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMSW
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Mailing Address - Street 1:2703 FRONTIER STE 120
Mailing Address - Street 2:UNM PRC ACL TEEN CENTERS MSC 11 6145
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-4462
Mailing Address - Fax:505-272-4857
Practice Address - Street 1:I40 W EXIT 131 HIGHWAY 56 N
Practice Address - Street 2:ACL TEEN CENTERS TO'HAJIILEE COMMUNITY SCHOOL
Practice Address - City:TO'HAJIILEE
Practice Address - State:NM
Practice Address - Zip Code:87026
Practice Address - Country:US
Practice Address - Phone:505-908-2377
Practice Address - Fax:505-908-2370
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2012-08-16
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Provider Licenses
StateLicense IDTaxonomies
NMM-06496104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM84020229Medicaid