Provider Demographics
NPI:1366682486
Name:DAVIS, RUTH (MFTI)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:DAVIS FYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1021 MCKINLEY AVE
Mailing Address - Street 2:#6
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3958
Mailing Address - Country:US
Mailing Address - Phone:510-295-7208
Mailing Address - Fax:
Practice Address - Street 1:44000 OLD WARM SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-6145
Practice Address - Country:US
Practice Address - Phone:510-248-9649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52556101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
7418OtherCLINICAL ID