MEDICARE: MS. JOY RUTH 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
1	1041C0700X	Clinical Social Worker	33752	TX

General Provider Information

NPI Number	:	1467636266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOY RUTH LCSW

Provider Business Mailing Address
First Line	:	917 WALTER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-2938
Country	:	US
Telephone Number	:	512-474-6386
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 WALTER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-2938
Country	:	US
Telephone Number	:	512-474-6386
Fax Number	:

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

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	12/28/2007

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