Provider Demographics
NPI:1699000729
Name:JAFFE BIRNBAUM, RUTHANN (LCSW)
Entity Type:Individual
Prefix:
First Name:RUTHANN
Middle Name:
Last Name:JAFFE BIRNBAUM
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 1:60 PALMERS HILL RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2113
Mailing Address - Country:US
Mailing Address - Phone:203-629-2822
Mailing Address - Fax:203-629-2940
Practice Address - Street 1:60 PALMERS HILL RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2113
Practice Address - Country:US
Practice Address - Phone:203-629-2822
Practice Address - Fax:203-629-2940
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0024121041C0700X
NY036884-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical