Provider Demographics
NPI:1073834875
Name:CARUTHERS, MARILYN M
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:M
Last Name:CARUTHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46407-2618
Mailing Address - Country:US
Mailing Address - Phone:219-886-1320
Mailing Address - Fax:219-886-1319
Practice Address - Street 1:308 E 21ST AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407-2618
Practice Address - Country:US
Practice Address - Phone:219-886-1320
Practice Address - Fax:219-886-1319
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33001019A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker