Provider Demographics
NPI:1659019412
Name:CHAIDEZ RUACHO, HECTOR ENRIQUE
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:ENRIQUE
Last Name:CHAIDEZ RUACHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6617
Mailing Address - Country:US
Mailing Address - Phone:203-785-2540
Mailing Address - Fax:
Practice Address - Street 1:350 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6617
Practice Address - Country:US
Practice Address - Phone:203-785-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT58.0122561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical