Provider Demographics
NPI: | 1780716456 |
---|---|
Name: | SATHER, RUTH BROMERT (LCSW) |
Entity type: | Individual |
Prefix: | |
First Name: | RUTH |
Middle Name: | BROMERT |
Last Name: | SATHER |
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: | 4626 TRAIL RIDGE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | BLAIR |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68008-6217 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 402-660-3374 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4626 TRAIL RIDGE RD |
Practice Address - Street 2: | |
Practice Address - City: | BLAIR |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68008-6217 |
Practice Address - Country: | US |
Practice Address - Phone: | 402-660-3374 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2007-03-09 |
Last Update Date: | 2024-03-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 1034 | 104100000X, 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NE | 10413 | Other | MIDLANDS CHOICE |
NE | 115628000 | Other | MAGELLAN BEHAVIORAL HEALT |
NE | 82355 | Other | BLUE CROSS BLUE SHIELD |