Provider Demographics
NPI:1447588322
Name:RUIZ, OMAR ALBERTO (LMFT)
Entity type:Individual
Prefix:MR
First Name:OMAR
Middle Name:ALBERTO
Last Name:RUIZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 DORCHESTER AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1386
Mailing Address - Country:US
Mailing Address - Phone:857-230-0313
Mailing Address - Fax:
Practice Address - Street 1:1452 DORCHESTER AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1386
Practice Address - Country:US
Practice Address - Phone:857-230-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1475106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist