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NPI Code Detail

MEDICARE: RUBY MOYE SALAZAR LCSW, BCD

MEDICARE: RUBY MOYE SALAZAR LCSW, BCD
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 WorkerCW-004836-LPA

General Provider Information

NPI Number : 1992880256
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUBY MOYE SALAZAR LCSW, BCD
Provider Business Mailing Address
First Line : 500 SCHOOL ST
Second Line :
City : CLARKS SUMMIT
State : PA
Zip : 18411-1508
Country : US
Telephone Number : 570-586-3587
Fax Number : 570-586-0337
Provider Business Practice Location Address
First Line : 500 SCHOOL ST
Second Line :
City : CLARKS SUMMIT
State : PA
Zip : 18411-1508
Country : US
Telephone Number : 570-586-3587
Fax Number : 570-586-0337
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/08/2007

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