Provider Demographics
NPI:1932181344
Name:PREVOR, RUTH CLAIRE (PHD,ABPP)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:CLAIRE
Last Name:PREVOR
Suffix:
Gender:F
Credentials:PHD,ABPP
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:CLAIRE
Other - Last Name:PREVOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:6000 ISLAND BLVD
Mailing Address - Street 2:SUITE 2904
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3762
Mailing Address - Country:US
Mailing Address - Phone:305-680-9544
Mailing Address - Fax:305-974-0426
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:SUITE 300
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:305-680-9544
Practice Address - Fax:305-974-0426
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-20
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR717103T00000X
FLPY9442103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-4182Medicare ID - Type UnspecifiedPROVIDER