Provider Demographics
NPI:1467642835
Name:URRUTIA, RUSSELL E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:E
Last Name:URRUTIA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 S JAY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3803
Mailing Address - Country:US
Mailing Address - Phone:303-564-6101
Mailing Address - Fax:303-935-0294
Practice Address - Street 1:75 MEADE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-1351
Practice Address - Country:US
Practice Address - Phone:303-504-1918
Practice Address - Fax:303-935-0294
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9924881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical