Provider Demographics
NPI:1841005774
Name:WYSHOGROD, RUTH (LCSW)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:WYSHOGROD
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 1:73 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01050-9777
Mailing Address - Country:US
Mailing Address - Phone:413-667-3009
Mailing Address - Fax:
Practice Address - Street 1:73 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:MA
Practice Address - Zip Code:01050-9777
Practice Address - Country:US
Practice Address - Phone:413-667-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231299104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker