Provider Demographics
NPI:1467574129
Name:SANDERSON, RUTH K (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:K
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CLIFF DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809
Mailing Address - Country:US
Mailing Address - Phone:401-253-2324
Mailing Address - Fax:
Practice Address - Street 1:1011 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-5061
Practice Address - Country:US
Practice Address - Phone:401-432-1000
Practice Address - Fax:401-432-1509
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILSW015851041C0700X
MA10209671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRS56549Medicaid
RI31146-1OtherBCBSRI
413191OtherBLUE CHIP
413191OtherBLUE CHIP