Healthcare Provider Details

I. General information

NPI: 1386790392
Provider Name (Legal Business Name): RUTH HOFSTATTER L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 PROSPECT AVE
HARTFORD CT
06105-4203
US

IV. Provider business mailing address

68 WHITING LN
WEST HARTFORD CT
06119-1641
US

V. Phone/Fax

Practice location:
  • Phone: 860-233-4830
  • Fax: 860-231-6222
Mailing address:
  • Phone: 860-233-4830
  • Fax: 860-231-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number03-364555
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: