Provider Demographics
NPI:1003567876
Name:RUIZ DE LUZURIAGA, ISABELLE G (LCSW)
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:G
Last Name:RUIZ DE LUZURIAGA
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 1:68 HARRISON AVE # 60588774
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1929
Mailing Address - Country:US
Mailing Address - Phone:781-443-8344
Mailing Address - Fax:844-364-6593
Practice Address - Street 1:68 HARRISON AVE # 60588774
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1929
Practice Address - Country:US
Practice Address - Phone:781-443-8344
Practice Address - Fax:844-364-6593
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2277501041C0700X
PASW1387051041C0700X
MA11201991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1588129001OtherSINGLE SPECIALTY GROUP