Provider Demographics
NPI:1609197011
Name:RUTTENBER, CLARICE VICTORIA (LMHC, CAP)
Entity Type:Individual
Prefix:MS
First Name:CLARICE
Middle Name:VICTORIA
Last Name:RUTTENBER
Suffix:
Gender:F
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 SE 39TH TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3153
Mailing Address - Country:US
Mailing Address - Phone:352-812-2257
Mailing Address - Fax:
Practice Address - Street 1:3233 MARICAMP RD
Practice Address - Street 2:SUITE 107
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6292
Practice Address - Country:US
Practice Address - Phone:352-812-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-20
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 4096101YA0400X
FLMH10270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)