Provider Demographics
NPI:1285841445
Name:SAMUEL, RUTH (MED, MS, LMFT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MED, MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1630
Mailing Address - Country:US
Mailing Address - Phone:201-871-4601
Mailing Address - Fax:201-871-3366
Practice Address - Street 1:194 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1630
Practice Address - Country:US
Practice Address - Phone:201-871-4601
Practice Address - Fax:201-871-3366
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJF1001179106H00000X
NY000355106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist