Active NPI
Mark Louis Ruffalo Jr., MSW, ACSW, LCSW
- Psychoanalyst
- Tampa, FL
National Provider Identifier
1104160241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychoanalyst
- Practice address
- 10335 Cross Creek Blvd
Suite 15
Tampa, FL 33647-2795 - Phone
- (727) 266-0270
- NPI assigned
- Nov 15, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | Primary | ||
| Clinical Social Worker | 1041C0700X | C009504 | NC | |
| Clinical Social Worker | 1041C0700X | SW12857 | FL |
Addresses
Primary practice location
10335 Cross Creek Blvd
Suite 15
Tampa, FL 33647-2795
Mailing address
10335 Cross Creek Blvd
Suite 15
Tampa, FL 33647-2795
Phone (727) 266-0270
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW12857 | FL | MD | Clinical Social Worker |
| C009504 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1352937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474329600000",
"number": "1104160241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10335 CROSS CREEK BLVD",
"address_2": "SUITE 15",
"city": "TAMPA",
"state": "FL",
"postal_code": "336472795",
"telephone_number": "727-266-0270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10335 CROSS CREEK BLVD",
"address_2": "SUITE 15",
"city": "TAMPA",
"state": "FL",
"postal_code": "336472795",
"telephone_number": "727-266-0270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUFFALO",
"first_name": "MARK",
"middle_name": "LOUIS",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "MSW, ACSW, LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-11-15",
"last_updated": "2016-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": null,
"license": null,
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C009504",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW12857",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.