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NPI Code Detail

MEDICARE: MRS. ELLEN RUTH EANET LCSW

MEDICARE: MRS. ELLEN RUTH EANET 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 WorkerR003722NY

General Provider Information

NPI Number : 1831391457
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELLEN RUTH EANET LCSW
Provider Business Mailing Address
First Line : 219 BERKELEY PLACE
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-3801
Country : US
Telephone Number : 718-622-2459
Fax Number : 718-622-6836
Provider Business Practice Location Address
First Line : 219 BERKELEY PLACE
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-3801
Country : US
Telephone Number : 718-622-2459
Fax Number : 718-622-6836
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2007
Last Update Date : 07/08/2007

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