Provider Demographics
NPI:1124188891
Name:MANLEY, RUTH H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:H
Last Name:MANLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 PODUNK RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2284
Mailing Address - Country:US
Mailing Address - Phone:203-430-5971
Mailing Address - Fax:203-453-8382
Practice Address - Street 1:20 DUNK ROCK RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2509
Practice Address - Country:US
Practice Address - Phone:203-430-5971
Practice Address - Fax:203-453-8382
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800004147OtherMEDICARE PTAN
800003679Medicare ID - Type Unspecified