Provider Demographics
NPI:1497995229
Name:MOSS, RUTH (LICSW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:MOSS
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 1:64 NEW YORK AVE NE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3320
Mailing Address - Country:US
Mailing Address - Phone:202-673-7013
Mailing Address - Fax:202-673-7502
Practice Address - Street 1:64 NEW YORK AVE NE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3320
Practice Address - Country:US
Practice Address - Phone:202-673-7013
Practice Address - Fax:202-673-7502
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC302924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health