Provider Demographics
NPI:1225111404
Name:RUTRICK GOLDSTEIN, DAVIDA LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DAVIDA
Middle Name:LYNN
Last Name:RUTRICK GOLDSTEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 ROCK CREEK LANE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583
Mailing Address - Country:US
Mailing Address - Phone:914-722-0264
Mailing Address - Fax:
Practice Address - Street 1:213 ROCK CREEK LN
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-7442
Practice Address - Country:US
Practice Address - Phone:914-260-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0234261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNA936091Medicaid
NYNA936091Medicaid