Healthcare Provider Details

I. General information

NPI: 1093013062
Provider Name (Legal Business Name): KARA H. RUTHENBERG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 FIRST PARK TEN BLVD STE 222
SAN ANTONIO TX
78213-4304
US

IV. Provider business mailing address

6655 FIRST PARK TEN BLVD STE 222
SAN ANTONIO TX
78213-4304
US

V. Phone/Fax

Practice location:
  • Phone: 210-496-2323
  • Fax: 888-496-3340
Mailing address:
  • Phone: 210-496-2323
  • Fax: 888-496-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC01029600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: