Provider Demographics
NPI:1912254368
Name:FREEMAN, RUTH EDNA (LMSW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:EDNA
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:EDNA
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:631 EDGECOMBE AVE
Mailing Address - Street 2:#1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4323
Mailing Address - Country:US
Mailing Address - Phone:917-675-6908
Mailing Address - Fax:
Practice Address - Street 1:631 EDGECOMBE AVE
Practice Address - Street 2:#1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4323
Practice Address - Country:US
Practice Address - Phone:917-675-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0844691104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker