Provider Demographics
NPI:1588869630
Name:HART, RUTH COOKE (LCSW,MFT,CAP)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:COOKE
Last Name:HART
Suffix:
Gender:F
Credentials:LCSW,MFT,CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 MIRROR TER NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-2352
Mailing Address - Country:US
Mailing Address - Phone:863-258-1203
Mailing Address - Fax:863-292-2201
Practice Address - Street 1:630 POPE AVE NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4665
Practice Address - Country:US
Practice Address - Phone:863-292-2201
Practice Address - Fax:863-292-2201
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2582101YA0400X
FL00025311041C0700X
FL0001357106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ020KOtherBLUE CROSS
FLE8910Medicare ID - Type UnspecifiedMEDICARE