Provider Demographics
NPI:1275713356
Name:RUTH A. GOLDBLOOM, P.A.
Entity Type:Organization
Organization Name:RUTH A. GOLDBLOOM, P.A.
Other - Org Name:CASSELMAN COUNSELING CONSORTIUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERN& CHIEF CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:GOLDBLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LPC
Authorized Official - Phone:301-895-3388
Mailing Address - Street 1:12590 NATIONAL PIKE
Mailing Address - Street 2:P O BOX 268
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-3310
Mailing Address - Country:US
Mailing Address - Phone:301-895-3388
Mailing Address - Fax:301-895-3399
Practice Address - Street 1:12590 NATIONAL PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-3310
Practice Address - Country:US
Practice Address - Phone:301-895-3388
Practice Address - Fax:301-895-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health