MEDICARE: RUTH DURAN DEFFLEY 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	6472	GA

General Provider Information

NPI Number	:	1538643481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH DURAN DEFFLEY LCSW

Provider Business Mailing Address
First Line	:	1509 ABERCORN ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31401-7315
Country	:	US
Telephone Number	:	912-225-6959
Fax Number	:	912-225-5144

Provider Business Practice Location Address
First Line	:	1509 ABERCORN ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31401-7315
Country	:	US
Telephone Number	:	912-225-6959
Fax Number	:

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

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	06/10/2025

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