MEDICARE: MS. RUTH GRETO DENNIS M.A.

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
1	103TC0700X	Clinical Psychologist	PS006759L	PA

General Provider Information

NPI Number	:	1417920588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTH GRETO DENNIS M.A.

Provider Business Mailing Address
First Line	:	39 S LAKE ST
Second Line	:
City	:	NORTH EAST
State	:	PA
Zip	:	16428-1239
Country	:	US
Telephone Number	:	814-725-8545
Fax Number	:	814-725-8545

Provider Business Practice Location Address
First Line	:	39 S LAKE ST
Second Line	:
City	:	NORTH EAST
State	:	PA
Zip	:	16428-1239
Country	:	US
Telephone Number	:	814-725-8545
Fax Number	:	814-725-8545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	07/08/2007

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