1588068126 NPI number — MS. DEANN RUTH SCHULTZ MSW, LCSW-C

Table of content: MS. DEANN RUTH SCHULTZ MSW, LCSW-C (NPI 1588068126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588068126 NPI number — MS. DEANN RUTH SCHULTZ MSW, LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULTZ
Provider First Name:
DEANN
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SITES
Provider Other First Name:
DEANN
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588068126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 CYPRESS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEYSER
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26726-8445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-851-0458
Provider Business Mailing Address Fax Number:
304-262-1417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 BUTLER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25405-9990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-263-0811
Provider Business Practice Location Address Fax Number:
304-262-1417
Provider Enumeration Date:
10/10/2014

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: 1041C0700X , with the licence number:  17413 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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