Provider Demographics
NPI:1962615914
Name:WEBSTER, RUTH VIRGINIA L (LCSW-C)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:VIRGINIA L
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:L
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1123
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-1123
Mailing Address - Country:US
Mailing Address - Phone:301-609-4675
Mailing Address - Fax:
Practice Address - Street 1:8220 MEGAN LN
Practice Address - Street 2:
Practice Address - City:PORT TOBACCO
Practice Address - State:MD
Practice Address - Zip Code:20677-2008
Practice Address - Country:US
Practice Address - Phone:240-523-3933
Practice Address - Fax:301-884-4225
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD58956180Medicaid
MD58956180Medicaid