Provider Demographics
NPI:1003939109
Name:JAEGER, RUTH (LCSW)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:JAEGER
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 1:108 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1542
Mailing Address - Country:US
Mailing Address - Phone:415-924-0122
Mailing Address - Fax:415-924-0122
Practice Address - Street 1:1330 LINCOLN AVE
Practice Address - Street 2:307
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2120
Practice Address - Country:US
Practice Address - Phone:415-924-0122
Practice Address - Fax:415-024-0122
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS68921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19130ZMedicare UPIN