MEDICARE: LAKESHA S. RUTH

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1932325594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKESHA S. RUTH

Provider Business Mailing Address
First Line	:	24 HIGH CT
Second Line	:	APT 3
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-1834
Country	:	US
Telephone Number	:	860-655-3145
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 HIGH CT
Second Line	:	APT 3
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-1834
Country	:	US
Telephone Number	:	860-655-3145
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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