Provider Demographics
NPI:1588956767
Name:NORMAN, RUTH A (LICSW)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:A
Last Name:NORMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:DR
Other - First Name:RUTHIE
Other - Middle Name:
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:115 QUARTUS ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-4015
Mailing Address - Country:US
Mailing Address - Phone:413-433-0332
Mailing Address - Fax:
Practice Address - Street 1:1029 NORTH RD STE 22
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085
Practice Address - Country:US
Practice Address - Phone:413-433-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MA1177431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1609352988OtherNP1 TYPE 2