Basic Information
| Provider Information | |||||||||
| NPI: | 1386882454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBY | ||||||||
| FirstName: | LAURENTIA | ||||||||
| MiddleName: | MEADE | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10195 MAIN ST | ||||||||
| Address2: | SUITE N | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220313415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035919600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10195 MAIN ST | ||||||||
| Address2: | SUITE N | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220313415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035919600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2009 | ||||||||
| LastUpdateDate: | 01/28/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0810003761 | VA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | PSY1000407 | DC | N | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.