Provider Demographics
NPI:1649485376
Name:RUARK, MARY MOSELEY (MA PA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MOSELEY
Last Name:RUARK
Suffix:
Gender:F
Credentials:MA PA
Other - Prefix:
Other - First Name:MOSELEY
Other - Middle Name:
Other - Last Name:RUARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA PA
Mailing Address - Street 1:3021 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474
Mailing Address - Country:US
Mailing Address - Phone:352-237-3440
Mailing Address - Fax:352-237-4381
Practice Address - Street 1:3021 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:352-237-3440
Practice Address - Fax:352-237-4381
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z2112OtherBCBS