Provider Demographics
NPI:1548316722
Name:RUIZ, ELLEN VARVITSIOTES (MFT)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:VARVITSIOTES
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 DELAWARE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1672
Mailing Address - Country:US
Mailing Address - Phone:510-524-2398
Mailing Address - Fax:510-288-1337
Practice Address - Street 1:1026 OAK GROVE RD
Practice Address - Street 2:SUITE 11
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3289
Practice Address - Country:US
Practice Address - Phone:925-646-5459
Practice Address - Fax:915-646-5102
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42350106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist