MEDICARE: MS. RUTH S GRULICH LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	Q1-0000309	DE

General Provider Information

NPI Number	:	1164439287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTH S GRULICH LCSW

Provider Business Mailing Address
First Line	:	62 N CHAPEL ST
Second Line	:	SUITE 100
City	:	NEWARK
State	:	DE
Zip	:	19711-2238
Country	:	US
Telephone Number	:	302-738-3305
Fax Number	:	302-738-4103

Provider Business Practice Location Address
First Line	:	62 N CHAPEL ST
Second Line	:	SUITE 100
City	:	NEWARK
State	:	DE
Zip	:	19711-2238
Country	:	US
Telephone Number	:	302-738-3305
Fax Number	:	302-738-4103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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