Basic Information
| Provider Information | |||||||||
| NPI: | 1427112127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUECKERT | ||||||||
| FirstName: | DEAN | ||||||||
| MiddleName: | MALZAHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D., LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6900 GEORGIA AVE NW | ||||||||
| Address2: | 2J38 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203070003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027837250 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | DSW, BORDEN PAVILION, BLDG. #6, WRAMC | ||||||||
| Address2: | 1044 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203075001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023561012 | ||||||||
| FaxNumber: | 2027824922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 07431 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.