Provider Demographics
NPI:1972560647
Name:DENATALE, RUTH A (PHD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:DENATALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:SCIOTA
Mailing Address - State:PA
Mailing Address - Zip Code:18354-0413
Mailing Address - Country:US
Mailing Address - Phone:973-886-7452
Mailing Address - Fax:570-402-1144
Practice Address - Street 1:3 MUIRFIELD LANE
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1234
Practice Address - Country:US
Practice Address - Phone:973-886-7452
Practice Address - Fax:570-402-1144
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100288000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5421900Medicaid
S03122Medicare UPIN
NJ5421900Medicaid