Provider Demographics
NPI:1740210681
Name:RUTTENBERG, BRENDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:RUTTENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5929 EVERGREEN WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6031
Mailing Address - Country:US
Mailing Address - Phone:206-617-6002
Mailing Address - Fax:425-259-5270
Practice Address - Street 1:5929 EVERGREEN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6031
Practice Address - Country:US
Practice Address - Phone:206-617-6002
Practice Address - Fax:425-259-5270
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60078953103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist