Provider Demographics
NPI:1891520334
Name:MARCELLINO, RUTH LEAH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:LEAH
Last Name:MARCELLINO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WETTAW LN APT 30
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5681
Mailing Address - Country:US
Mailing Address - Phone:561-512-8049
Mailing Address - Fax:
Practice Address - Street 1:4590 PGA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3938
Practice Address - Country:US
Practice Address - Phone:561-512-8049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL77871041C0700X
FLSW77871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical