Basic Information
| Provider Information | |||||||||
| NPI: | 1881810034 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | BROWN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 EAST CHAPEL HILL ST. | ||||||||
| Address2: | EL FUTURO | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196887101 | ||||||||
| FaxNumber: | 9196887102 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 W. MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CARRBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193381939 | ||||||||
| FaxNumber: | 9193382729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 11/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C004919 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 142E7 | 01 | NC | BCBS OF NC | OTHER |