Provider Demographics
NPI:1679796239
Name:COMMONWEALTH MENTAL HEALTH ASSOC
Entity Type:Organization
Organization Name:COMMONWEALTH MENTAL HEALTH ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RUTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-569-2168
Mailing Address - Street 1:8322 D TRAFORD LANE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152
Mailing Address - Country:US
Mailing Address - Phone:703-913-3503
Mailing Address - Fax:703-913-1193
Practice Address - Street 1:8322 D TRAFORD LANE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152
Practice Address - Country:US
Practice Address - Phone:703-913-3503
Practice Address - Fax:703-913-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty