MEDICARE: RUTH ANNE ELLERD 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	R055718-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972573491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ANNE ELLERD LCSW

Provider Business Mailing Address
First Line	:	28 N COUNTRY RD
Second Line	:
City	:	MOUNT SINAI
State	:	NY
Zip	:	11766-1518
Country	:	US
Telephone Number	:	631-375-5663
Fax Number	:	631-473-0733

Provider Business Practice Location Address
First Line	:	28 N COUNTRY RD
Second Line	:
City	:	MOUNT SINAI
State	:	NY
Zip	:	11766-1518
Country	:	US
Telephone Number	:	631-375-5663
Fax Number	:	631-473-0733

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	01/22/2015

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