Provider Demographics
NPI:1649695057
Name:AYZENBERG, RUTHIE MARYANNE
Entity type:Individual
Prefix:
First Name:RUTHIE
Middle Name:MARYANNE
Last Name:AYZENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RUTHIE
Other - Middle Name:
Other - Last Name:KUCHEVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4276 WILKIE WAY APT D
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-4431
Mailing Address - Country:US
Mailing Address - Phone:443-929-1137
Mailing Address - Fax:
Practice Address - Street 1:206 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1618
Practice Address - Country:US
Practice Address - Phone:650-617-8340
Practice Address - Fax:650-321-5468
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist