Healthcare Provider Details

I. General information

NPI: 1851796460
Provider Name (Legal Business Name): RUTH ANN HER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH ANN AVINA LOREDO LCSW

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 W OLIVE AVE # K4
MERCED CA
95348-1900
US

IV. Provider business mailing address

1180 W OLIVE AVE # K4
MERCED CA
95348-1900
US

V. Phone/Fax

Practice location:
  • Phone: 209-600-3620
  • Fax: 559-675-5224
Mailing address:
  • Phone: 209-600-3620
  • Fax: 559-675-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32842
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW92961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: