Provider Demographics
NPI:1508848680
Name:KUTZ, RUTH C
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:C
Last Name:KUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:CAROLINE
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:806 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3153
Mailing Address - Country:US
Mailing Address - Phone:315-475-5433
Mailing Address - Fax:315-422-4203
Practice Address - Street 1:806 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-3153
Practice Address - Country:US
Practice Address - Phone:315-422-9462
Practice Address - Fax:315-422-4203
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0168131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS99442Medicare UPIN
NYDD2026Medicare ID - Type Unspecified