Provider Demographics
NPI:1710395868
Name:RUARK, HEATHER A (LCSW-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:RUARK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 GODDARD PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1126
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6362
Practice Address - Street 1:2336 GODDARD PKWY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-1126
Practice Address - Country:US
Practice Address - Phone:410-334-6961
Practice Address - Fax:410-334-6362
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD197261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD346646OtherMHN
MD609550001Medicaid
MD52156095OtherAMERICAN PSYCH SYSTEM
MD517251OtherOPTUM-UBH
MD522156095OtherCIGNA
MDLM49EAOtherCAREFIRST BCBS
MDR968OtherCAREFIRST
MD7840093OtherAETNA
MD259147-000OtherMAGELLAN BEHAVIORAL HEALTH
MD609550001Medicaid