Healthcare Provider Details

I. General information

NPI: 1841005774
Provider Name (Legal Business Name): RUTH WYSHOGROD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 RUSSELL RD
HUNTINGTON MA
01050-9777
US

IV. Provider business mailing address

73 RUSSELL RD
HUNTINGTON MA
01050-9777
US

V. Phone/Fax

Practice location:
  • Phone: 413-667-3009
  • Fax:
Mailing address:
  • Phone: 413-667-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number231299
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: