Provider Demographics
NPI:1003839895
Name:RUTTER, STEVEN GERALD (MSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:GERALD
Last Name:RUTTER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MILFORD DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3233
Mailing Address - Country:US
Mailing Address - Phone:516-935-6608
Mailing Address - Fax:516-505-2011
Practice Address - Street 1:22 MILFORD DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3233
Practice Address - Country:US
Practice Address - Phone:516-935-6608
Practice Address - Fax:516-505-2011
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW PRO23427-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN13092Medicare ID - Type UnspecifiedMEDICARE