Provider Demographics
NPI:1275968190
Name:PRUTCHI, DORITH (MSS, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DORITH
Middle Name:
Last Name:PRUTCHI
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 1:525 ROUTE 73 N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3422
Mailing Address - Country:US
Mailing Address - Phone:609-510-3271
Mailing Address - Fax:
Practice Address - Street 1:140 S BROADWAY
Practice Address - Street 2:#7
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-2235
Practice Address - Country:US
Practice Address - Phone:844-365-7676
Practice Address - Fax:844-365-7676
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055515001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical