Provider Demographics
NPI:1689725806
Name:RUTTER, EILEEN F (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:F
Last Name:RUTTER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2527
Mailing Address - Country:US
Mailing Address - Phone:845-268-4590
Mailing Address - Fax:
Practice Address - Street 1:56 RIDGE RD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2527
Practice Address - Country:US
Practice Address - Phone:845-268-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO25294-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical