Ruth Marya Fankushen, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

94555 Issued in CA

Practice address

2655 Portage Bay E Ste 4
Davis, CA 95616-3073

Phone

(530) 507-8647

Fax

(530) 302-3388

NPI assigned

May 13, 2014

Last updated

Sep 19, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1386055341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 PORTAGE BAY E STE 4",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956163073",
            "telephone_number": "530-507-8647",
            "fax_number": "530-302-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 PORTAGE BAY E STE 4",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956163073",
            "telephone_number": "530-507-8647",
            "fax_number": "530-302-3388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "455 1st St",
            "address_purpose": "LOCATION",
            "city": "Woodland",
            "state": "CA",
            "postal_code": "956954023",
            "country_code": "US",
            "telephone_number": "530-662-2211 x26",
            "fax_number": "530-662-4315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANKUSHEN",
        "first_name": "RUTH",
        "middle_name": "MARYA",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-13",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF 74268",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "94555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eye Sea Optometry Apc (Eye Sea Davis Optometry)
• Maryjane Fabricius-Mooneyham
• Zachary Fairbrook
• Karen Falakfarsa, MFT
• Michelle Sherman Famula, M.D.
• Dorene Fanning, LCSW
• Vahid Farahyar, DDS
• Cassandra Farinsky, RN
• Samantha Farkash, DDS
• Karen Louise Farley, RD, IBCLC

• Marriage & Family Therapist in Davis, CA
• Providers in Davis, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.