Provider Demographics
NPI:1669507794
Name:ROSEN, RUTH LILLIAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:LILLIAN
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHANNING AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5510
Mailing Address - Country:US
Mailing Address - Phone:401-421-8829
Mailing Address - Fax:401-421-1896
Practice Address - Street 1:15 CHANNING AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5510
Practice Address - Country:US
Practice Address - Phone:401-421-8829
Practice Address - Fax:401-421-1896
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW002181041C0700X
MA1051811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical