Provider Demographics
NPI:1376046755
Name:DOBEK, RUTHANN
Entity Type:Individual
Prefix:
First Name:RUTHANN
Middle Name:
Last Name:DOBEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2755
Mailing Address - Country:US
Mailing Address - Phone:617-730-2756
Mailing Address - Fax:617-730-2761
Practice Address - Street 1:93 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2755
Practice Address - Country:US
Practice Address - Phone:617-730-2756
Practice Address - Fax:617-730-2761
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106283104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA106283OtherCOMMONWEALTH OF MASSACHUSETTS SOCIAL WORK LICENSE