Provider Demographics
NPI:1972686004
Name:WARD, CATHERINE RUBY (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:CATHERINE
Middle Name:RUBY
Last Name:WARD
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:PO BOX 1123
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1123
Mailing Address - Country:US
Mailing Address - Phone:208-743-8101
Mailing Address - Fax:208-746-7402
Practice Address - Street 1:1020 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1842
Practice Address - Country:US
Practice Address - Phone:208-743-8101
Practice Address - Fax:208-746-7402
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-25694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health