Provider Demographics
NPI:1598790370
Name:MYERS, RUTH ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:RUTH ANN
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:RUTH ANN
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:940 WATER ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:NORTH BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05257-9814
Mailing Address - Country:US
Mailing Address - Phone:802-753-1571
Mailing Address - Fax:802-442-1200
Practice Address - Street 1:940 WATER ST UNIT 9
Practice Address - Street 2:
Practice Address - City:NORTH BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05257-9814
Practice Address - Country:US
Practice Address - Phone:802-753-1571
Practice Address - Fax:802-442-1200
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT89-00000551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0333Medicaid
VTOVN0333Medicaid