Provider Demographics
NPI:1326421892
Name:GLASS, RUTH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NETHERLAND AVE APT 809
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4827
Mailing Address - Country:US
Mailing Address - Phone:310-351-4236
Mailing Address - Fax:
Practice Address - Street 1:2600 NETHERLAND AVE APT 809
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4827
Practice Address - Country:US
Practice Address - Phone:310-351-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30064103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral