Provider Demographics
NPI:1124592407
Name:RUTHERFORD, JOSHUA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2478 FRANKFORD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1663
Mailing Address - Country:US
Mailing Address - Phone:804-307-1837
Mailing Address - Fax:
Practice Address - Street 1:1700 N BROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-3429
Practice Address - Country:US
Practice Address - Phone:804-307-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018706103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical