Individual
MS. AMANDA KAROL RUIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
517 JUSTINE CT, BAY SHORE, NY 11706-5861
(631) 833-1451
Mailing address
517 JUSTINE CT, BAY SHORE, NY 11706-5861
(631) 833-1451
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
112492
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
088511
LICENSURE
NY
01
—
112492
ASWB
NY
Enumeration date
04/28/2021
Last updated
04/28/2021
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