Provider Demographics
NPI:1699947606
Name:RUTH S. FIELDER
Entity type:Organization
Organization Name:RUTH S. FIELDER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:S
Authorized Official - Last Name:FIELDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-977-5272
Mailing Address - Street 1:3619 BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24064-1976
Mailing Address - Country:US
Mailing Address - Phone:540-977-5272
Mailing Address - Fax:540-977-5273
Practice Address - Street 1:4656 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3437
Practice Address - Country:US
Practice Address - Phone:540-772-8043
Practice Address - Fax:540-772-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040040211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010190169Medicaid
VA181806OtherANTHEM
VA812168000OtherMAGELLAN
VA010190169Medicaid