Provider Demographics
NPI:1821038795
Name:SHOR JANNATI, RUTH MADELINE (LSW C)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:MADELINE
Last Name:SHOR JANNATI
Suffix:
Gender:F
Credentials:LSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SISTER PIERRE DRIVE
Mailing Address - Street 2:403
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-823-6408
Mailing Address - Fax:443-279-0537
Practice Address - Street 1:7130 MINSTREL WAY
Practice Address - Street 2:212
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-290-6940
Practice Address - Fax:410-290-9763
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
399602OtherMAMS INDIVIDUAL
61605107OtherBSMD INDIVIDUAL
0025OtherBSDC INDIVIDUAL
150NOtherMBMD GROUP
360218OtherMHN GROUP
PVPB129359OtherAPS GROUP
226269OtherKAIS INDIVIDUAL
252450OtherCOMP GROUP
331948OtherMHN INDIVIDUAL
PVPB129359OtherAPS INDIVIDUAL
150N136GOtherMBMD INDIVIDUAL
253556OtherCOMP INDIVIDUAL
705BPSOtherBSMD GROUP
K452OtherBSDC GROUP
226269OtherKAIS GROUP
252450OtherCOMP GROUP
61605107OtherBSMD INDIVIDUAL