Provider Demographics
NPI:1609888973
Name:FEILBERT-WILLIS, RUTHE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RUTHE
Middle Name:
Last Name:FEILBERT-WILLIS
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 1:25 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-1201
Mailing Address - Country:US
Mailing Address - Phone:203-431-6558
Mailing Address - Fax:
Practice Address - Street 1:25 CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-1201
Practice Address - Country:US
Practice Address - Phone:203-431-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003295101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTFR441394OtherPIN # GHI
CT140003295CT01OtherBCC/BS CT
CTR20174OtherVALUEOPTIONS, ID
CT4256449OtherAETNA PROVIDER #
CT003295OtherCONNECTICUT LICENSE
CT108129OtherMHN VENDOR
CTP395133OtherOXFORD, PROVIDER #
CT4256449OtherAETNA PROVIDER #