Basic Information
Provider Information
NPI: 1578788212
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAVIS
FirstName: RUTH
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: PSY.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 EAST JEFFERSON STREET
Address2: KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
City: ROCKVILLE
State: MD
PostalCode: 20852
CountryCode: US
TelephoneNumber: 3018166660
FaxNumber: 3018166308
Practice Location
Address1: 1011 N CAPITOL ST NE
Address2: 4TH FLOOR
City: WASHINGTON
State: DC
PostalCode: 200024236
CountryCode: US
TelephoneNumber: 2028985258
FaxNumber: 2028985103
Other Information
ProviderEnumerationDate: 04/16/2007
LastUpdateDate: 11/30/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000XPSY1275DCY Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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