=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285841445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH SAMUEL M.ED., M.S., L.M.F.T
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 194 JEFFERSON AVE
-----------------------------------------------------
City | TENAFLY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07670-1630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-871-4601
-----------------------------------------------------
Fax | 201-871-3366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 194 JEFFERSON AVE
-----------------------------------------------------
City | TENAFLY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07670-1630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-871-4601
-----------------------------------------------------
Fax | 201-871-3366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | F1001179
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000355
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------