Provider Demographics
NPI:1528380136
Name:MEYER, RUTH M (LCSW-R, CASAC)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:M
Last Name:MEYER
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3281 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE E14
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7676
Mailing Address - Country:US
Mailing Address - Phone:631-471-3122
Mailing Address - Fax:631-471-3036
Practice Address - Street 1:3281 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE E14
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7676
Practice Address - Country:US
Practice Address - Phone:631-471-3122
Practice Address - Fax:631-471-3036
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3961101YA0400X
NYR042744-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01662344Medicaid