Healthcare Provider Details

I. General information

NPI: 1972573491
Provider Name (Legal Business Name): RUTH ANNE ELLERD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N COUNTRY RD
MOUNT SINAI NY
11766-1518
US

IV. Provider business mailing address

28 N COUNTRY RD
MOUNT SINAI NY
11766-1518
US

V. Phone/Fax

Practice location:
  • Phone: 631-375-5663
  • Fax: 631-473-0733
Mailing address:
  • Phone: 631-375-5663
  • Fax: 631-473-0733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR055718-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: