Provider Demographics
NPI:1780732826
Name:RUIZ-DIAZ, ELENA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELENA
Middle Name:M
Last Name:RUIZ-DIAZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WOODRIDGE DR S
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-8301
Mailing Address - Country:US
Mailing Address - Phone:203-323-1251
Mailing Address - Fax:203-249-5048
Practice Address - Street 1:19 GREENRIDGE AVE
Practice Address - Street 2:ANDRUS CHILDREN'S CENTER
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1201
Practice Address - Country:US
Practice Address - Phone:914-949-7680
Practice Address - Fax:203-274-5491
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO12257-11041C0700X
CT0014141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355940Medicaid
NY1285628552OtherNPI JULIA DYCKMAN ANDRUS
NY00355940Medicaid