Provider Demographics
NPI:1982829057
Name:FOGARTY, RUTH SYLVIA (MA LICENSED MENTAL)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:SYLVIA
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:MA LICENSED MENTAL
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:SYLVIA
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 MONACO DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624
Mailing Address - Country:US
Mailing Address - Phone:585-247-1512
Mailing Address - Fax:585-247-1512
Practice Address - Street 1:11 MONACO DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624
Practice Address - Country:US
Practice Address - Phone:585-247-1512
Practice Address - Fax:585-247-1512
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health