MEDICARE: RUTHANN JAFFE BIRNBAUM 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	002412	CT
2	1041C0700X	Clinical Social Worker	036884-1	NY

General Provider Information

NPI Number	:	1699000729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTHANN JAFFE BIRNBAUM LCSW

Provider Business Mailing Address
First Line	:	60 PALMERS HILL RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-2113
Country	:	US
Telephone Number	:	203-629-2822
Fax Number	:	203-629-2940

Provider Business Practice Location Address
First Line	:	60 PALMERS HILL RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-2113
Country	:	US
Telephone Number	:	203-629-2822
Fax Number	:	203-629-2940

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

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	11/15/2011

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