Provider Demographics
NPI:1609093673
Name:GRAYBILL, RUTH ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ANN
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 ARROUES DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1924
Mailing Address - Country:US
Mailing Address - Phone:562-903-4799
Mailing Address - Fax:562-903-4802
Practice Address - Street 1:743 ARROUES DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1924
Practice Address - Country:US
Practice Address - Phone:562-903-4799
Practice Address - Fax:562-903-4802
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 86671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical