Provider Demographics
NPI:1396917886
Name:CARRUTH, SYLVIA (LMSW)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:CARRUTH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 DUPONT AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1911
Mailing Address - Country:US
Mailing Address - Phone:734-657-1351
Mailing Address - Fax:
Practice Address - Street 1:459 DUPONT AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1911
Practice Address - Country:US
Practice Address - Phone:734-657-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010641931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910829OtherBCBSM
MI230259Medicare PIN