Provider Demographics
NPI:1083356208
Name:RUTHERFORD, STEPHANIE VERNA
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:VERNA
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:VERNA
Other - Last Name:DIGGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:19 SICKLES PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-3807
Mailing Address - Country:US
Mailing Address - Phone:914-413-1428
Mailing Address - Fax:
Practice Address - Street 1:19 SICKLES PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-3807
Practice Address - Country:US
Practice Address - Phone:914-413-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker