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NPI Code Detail

MEDICARE: MS. RUTH CHRISTMAN MANDERNACH LCSW

MEDICARE: MS. RUTH CHRISTMAN MANDERNACH LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCS14861CA

General Provider Information

NPI Number : 1194857169
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RUTH CHRISTMAN MANDERNACH LCSW
Provider Business Mailing Address
First Line : 15339 SATICOY ST
Second Line :
City : VAN NUYS
State : CA
Zip : 91406-3345
Country : US
Telephone Number : 818-267-2756
Fax Number : 818-267-2770
Provider Business Practice Location Address
First Line : 15339 SATICOY ST
Second Line :
City : VAN NUYS
State : CA
Zip : 91406-3345
Country : US
Telephone Number : 818-267-2756
Fax Number : 818-267-2770
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 07/08/2007

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