Healthcare Provider Details

I. General information

NPI: 1003982034
Provider Name (Legal Business Name): RUTH CATHERINE KENRICK M.A., L.I. C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S PASEO TIERRA APT A
GREEN VALLEY AZ
85614-7408
US

IV. Provider business mailing address

135 S PASEO TIERRA APT A
GREEN VALLEY AZ
85614-7408
US

V. Phone/Fax

Practice location:
  • Phone: 802-258-7621
  • Fax: 520-355-7672
Mailing address:
  • Phone: 802-258-7621
  • Fax: 520-355-7672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4932
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0077060
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073803-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: