Healthcare Provider Details

I. General information

NPI: 1407907892
Provider Name (Legal Business Name): RUTH A. GOODE LISW-SUP, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 SW HWY 200, #110-115
OCALA FL
34476
US

IV. Provider business mailing address

6160 SW HWY 200, #110-115
OCALA FL
34476
US

V. Phone/Fax

Practice location:
  • Phone: 440-571-1340
  • Fax: 352-474-2131
Mailing address:
  • Phone: 440-571-1340
  • Fax: 352-474-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI2620 LISW-SUP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: