Provider Demographics
NPI:1477055812
Name:HOMER, RUTH ANN
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:HOMER
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 1:80 GATEWAY BLVD APT 209
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4560
Mailing Address - Country:US
Mailing Address - Phone:908-906-9449
Mailing Address - Fax:
Practice Address - Street 1:10 FORRESTAL RD S STE 203
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6666
Practice Address - Country:US
Practice Address - Phone:609-759-2750
Practice Address - Fax:609-919-9700
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00263700101YA0400X
NJ44SC05650000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)