Provider Demographics
NPI:1215107719
Name:LEVINE ARNOLD, RUTH (MS)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:LEVINE ARNOLD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ANNAWAN RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-2110
Mailing Address - Country:US
Mailing Address - Phone:617-965-1419
Mailing Address - Fax:617-965-6588
Practice Address - Street 1:42 ANNAWAN RD
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-2110
Practice Address - Country:US
Practice Address - Phone:617-965-1419
Practice Address - Fax:617-965-6588
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASP0217OtherBLUE CROSS BLUE SHIELD MA