Provider Demographics
NPI:1023173556
Name:CAMPBELL, RUTH (LCSW)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:CAMPBELL
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:PO BOX 1235
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-7235
Mailing Address - Country:US
Mailing Address - Phone:845-255-5022
Mailing Address - Fax:845-255-5022
Practice Address - Street 1:6 DUZINE RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1304
Practice Address - Country:US
Practice Address - Phone:845-255-5022
Practice Address - Fax:845-255-5022
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR044725-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02538778Medicaid
NYN267U1Medicare UPIN