1609888973 NPI number — MRS. RUTHE FEILBERT-WILLIS LCSW

Table of content: MRS. RUTHE FEILBERT-WILLIS LCSW (NPI 1609888973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609888973 NPI number — MRS. RUTHE FEILBERT-WILLIS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEILBERT-WILLIS
Provider First Name:
RUTHE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1609888973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 CHESTNUT HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGEFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06877-1201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-431-6558
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 CHESTNUT HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06877-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-431-6558
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2006

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: 101YA0400X , with the licence number:  003295 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 003295 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: FR441394 . This is a "PIN # GHI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 140003295CT01 . This is a "BCC/BS CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: R20174 . This is a "VALUEOPTIONS, ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4256449 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 003295 . This is a "CONNECTICUT LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 108129 . This is a "MHN VENDOR" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P395133 . This is a "OXFORD, PROVIDER #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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