Provider Demographics
NPI:1114015385
Name:DUTTON, ROSALIND (MSS, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSALIND
Middle Name:
Last Name:DUTTON
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 W HORTTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2706
Mailing Address - Country:US
Mailing Address - Phone:215-844-5407
Mailing Address - Fax:215-844-2714
Practice Address - Street 1:152 W HORTTER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2706
Practice Address - Country:US
Practice Address - Phone:215-844-5407
Practice Address - Fax:215-844-2714
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000734L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA633876Medicare PIN