1962615914 NPI number — RUTH VIRGINIA L. WEBSTER LCSW-C

Table of content: RUTH VIRGINIA L. WEBSTER LCSW-C (NPI 1962615914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962615914 NPI number — RUTH VIRGINIA L. WEBSTER LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBSTER
Provider First Name:
RUTH
Provider Middle Name:
VIRGINIA L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
WEBSTER
Provider Other First Name:
VIRGINIA
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962615914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1123
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PLATA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20646-1123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-609-4675
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8220 MEGAN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT TOBACCO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20677-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-523-3933
Provider Business Practice Location Address Fax Number:
301-884-4225
Provider Enumeration Date:
05/07/2007

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:  13819 , 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)

  • Identifier: 58956180 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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