1215680525 NPI number — RUTA CLAIR PSYD

Table of content: RUTA CLAIR PSYD (NPI 1215680525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215680525 NPI number — RUTA CLAIR PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAIR
Provider First Name:
RUTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215680525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 WHITEMARSH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARDMORE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19003-1615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-584-4662
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
483 E COUNTY LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19040-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-441-5670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X , with the licence number:  PS018755 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)