Provider Demographics
NPI:1417221706
Name:CHADWICK, ROUTH (LMSW)
Entity Type:Individual
Prefix:
First Name:ROUTH
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S 3RD ST
Mailing Address - Street 2:APT. 31
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4660
Mailing Address - Country:US
Mailing Address - Phone:917-208-8805
Mailing Address - Fax:
Practice Address - Street 1:160 W 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4018
Practice Address - Country:US
Practice Address - Phone:212-362-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-04
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077338104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker