Provider Demographics
NPI:1013027192
Name:MARKOWITZ, RUTH BROOKE (MA LICENSED PSYCHOLO)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:BROOKE
Last Name:MARKOWITZ
Suffix:
Gender:F
Credentials:MA LICENSED PSYCHOLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 PORTLAND AVE
Mailing Address - Street 2:#120
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2273
Mailing Address - Country:US
Mailing Address - Phone:651-222-5457
Mailing Address - Fax:651-291-2728
Practice Address - Street 1:614 PORTLAND AVE
Practice Address - Street 2:#120
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2273
Practice Address - Country:US
Practice Address - Phone:651-222-5457
Practice Address - Fax:651-291-2728
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 0368103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04525MAOtherBCBSM