Provider Demographics
NPI:1639409253
Name:LEUENBERGER, RUTH CLEMENCE (LPC)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:CLEMENCE
Last Name:LEUENBERGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SHAKER RD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3110
Mailing Address - Country:US
Mailing Address - Phone:860-749-2243
Mailing Address - Fax:
Practice Address - Street 1:72 SHAKER RD
Practice Address - Street 2:SUITE #7
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3110
Practice Address - Country:US
Practice Address - Phone:860-749-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional