Provider Demographics
NPI:1477909927
Name:FUTCHKO, DONNA (CSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:FUTCHKO
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 IKEA DR
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-5115
Mailing Address - Country:US
Mailing Address - Phone:609-267-9339
Mailing Address - Fax:609-267-6655
Practice Address - Street 1:25 IKEA DR
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-5115
Practice Address - Country:US
Practice Address - Phone:609-267-9339
Practice Address - Fax:609-267-6655
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW00640400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health