Provider Demographics
NPI:1720192313
Name:JAMPOL, RUTH (PHD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:JAMPOL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 STREET RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4250
Mailing Address - Country:US
Mailing Address - Phone:215-355-2011
Mailing Address - Fax:215-396-1886
Practice Address - Street 1:1111 STREET RD
Practice Address - Street 2:SUITE 312
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4250
Practice Address - Country:US
Practice Address - Phone:215-355-2011
Practice Address - Fax:215-396-1886
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005642L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1661669OtherIBC PERSONAL CHOICE
616750EEHMedicare ID - Type Unspecified