Provider Demographics
NPI:1992135396
Name:MARGO RUTH GROSS LLC
Entity type:Organization
Organization Name:MARGO RUTH GROSS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, OTR/L, LMFT, LM
Authorized Official - Phone:203-938-2308
Mailing Address - Street 1:15 POVERTY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-3005
Mailing Address - Country:US
Mailing Address - Phone:203-938-2308
Mailing Address - Fax:203-938-2308
Practice Address - Street 1:15 POVERTY HOLLOW RD
Practice Address - Street 2:27 GOVERNORS STREET, RIDDGEFIELD, CT 06877
Practice Address - City:REDDING
Practice Address - State:CT
Practice Address - Zip Code:06896-3005
Practice Address - Country:US
Practice Address - Phone:203-938-2308
Practice Address - Fax:203-938-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000097261QM1300X
CT000517261QM1300X
CT000083261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty