Provider Demographics
NPI:1558428052
Name:FESMIRE, RUTH LOUISE (MS, MFT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:LOUISE
Last Name:FESMIRE
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 VIA CABRILLO MARINA STE 200C
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-7224
Mailing Address - Country:US
Mailing Address - Phone:831-419-4875
Mailing Address - Fax:
Practice Address - Street 1:2500 VIA CABRILLO MARINA STE 200C
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731
Practice Address - Country:US
Practice Address - Phone:831-419-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28391106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist