Provider Demographics
NPI:1477097426
Name:RUTH, DAVID ALAN (MA, NCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:RUTH
Suffix:
Gender:M
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 OCEAN DR E
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-8219
Mailing Address - Country:US
Mailing Address - Phone:203-588-0638
Mailing Address - Fax:
Practice Address - Street 1:277 OCEAN DR E
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-8219
Practice Address - Country:US
Practice Address - Phone:203-588-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-10
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT742681OtherNBCC