MEDICARE: RUBY BOOTH LISW

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	I.1101086	OH

General Provider Information

NPI Number	:	1588972376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBY BOOTH LISW

Provider Business Mailing Address
First Line	:	3006 N HIGH ST
Second Line	:	SUITE 2A
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1145
Country	:	US
Telephone Number	:	614-725-1096
Fax Number	:	614-725-0196

Provider Business Practice Location Address
First Line	:	3006 N HIGH ST
Second Line	:	SUITE 2A
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1145
Country	:	US
Telephone Number	:	614-725-1096
Fax Number	:	614-725-0196

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

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	06/27/2017

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Directions to “ RUBY BOOTH LISW” Practice Location

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