Provider Demographics
NPI:1427122258
Name:MARCIAL, RUTH E (PSY D)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:E
Last Name:MARCIAL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GREGORY RD APT C
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-6033
Mailing Address - Country:US
Mailing Address - Phone:869-865-8810
Mailing Address - Fax:
Practice Address - Street 1:132 MANSFIELD AVE
Practice Address - Street 2:UNITED SERVICES, INC.
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2027
Practice Address - Country:US
Practice Address - Phone:860-456-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical