Provider Demographics
NPI:1184733826
Name:PINE, RUTH ROBIN (LCSW-R, MA)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ROBIN
Last Name:PINE
Suffix:
Gender:F
Credentials:LCSW-R, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1143
Mailing Address - Country:US
Mailing Address - Phone:845-443-9722
Mailing Address - Fax:
Practice Address - Street 1:65 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1143
Practice Address - Country:US
Practice Address - Phone:845-255-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045307104100000X
104100000X
NYR045307104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker