Provider Demographics
NPI:1407907892
Name:GOODE, RUTH A (LISW-SUP, ACSW)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:A
Last Name:GOODE
Suffix:
Gender:F
Credentials:LISW-SUP, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 SW HWY 200, #110-115
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476
Mailing Address - Country:US
Mailing Address - Phone:440-571-1340
Mailing Address - Fax:352-474-2131
Practice Address - Street 1:6160 SW HWY 200, #110-115
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476
Practice Address - Country:US
Practice Address - Phone:440-571-1340
Practice Address - Fax:352-474-2131
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI2620 LISW-SUP1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW14686OtherLCSW