Provider Demographics
NPI:1023065505
Name:CHAD, RUTH C (EDD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:C
Last Name:CHAD
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HYDE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1237
Mailing Address - Country:US
Mailing Address - Phone:617-965-3569
Mailing Address - Fax:
Practice Address - Street 1:95 HYDE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1237
Practice Address - Country:US
Practice Address - Phone:617-965-3569
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4624103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04454Medicare ID - Type Unspecified