Provider Demographics
NPI:1427112127
Name:RUECKERT, DEAN MALZAHN (PHD, LCSW-C)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:MALZAHN
Last Name:RUECKERT
Suffix:
Gender:M
Credentials:PHD, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 GEORGIA AVE NW
Mailing Address - Street 2:2J38
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307-0003
Mailing Address - Country:US
Mailing Address - Phone:202-783-7250
Mailing Address - Fax:
Practice Address - Street 1:DSW, BORDEN PAVILION, BLDG. #6, WRAMC
Practice Address - Street 2:1044
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-5001
Practice Address - Country:US
Practice Address - Phone:202-356-1012
Practice Address - Fax:202-782-4922
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD074311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical