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NPI Code Detail

MEDICARE: MRS. RUTH S FIELDER LCSW

MEDICARE: MRS. RUTH S FIELDER 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 Worker0904004021VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1181806OTHERVAANTHEM BCBS

General Provider Information

NPI Number : 1417916065
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RUTH S FIELDER LCSW
Provider Business Mailing Address
First Line : 26 BEACHVIEW LN
Second Line :
City : TROUTVILLE
State : VA
Zip : 24175-6751
Country : US
Telephone Number : 540-580-6300
Fax Number : 540-977-5273
Provider Business Practice Location Address
First Line : 4656 BRAMBLETON AVE
Second Line :
City : ROANOKE
State : VA
Zip : 24018-3437
Country : US
Telephone Number : 540-772-8043
Fax Number : 540-772-8242
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2006
Last Update Date : 03/31/2008

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