Provider Demographics
NPI:1326051194
Name:RUTKOWSKI, MARK ANTHONY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:RUTKOWSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:ANTHONY
Other - Last Name:RUTKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8322 TRAFORD LN # D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1668
Mailing Address - Country:US
Mailing Address - Phone:703-569-2168
Mailing Address - Fax:703-913-1193
Practice Address - Street 1:8322 TRAFORD LN # D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1668
Practice Address - Country:US
Practice Address - Phone:703-569-2168
Practice Address - Fax:703-913-1193
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical