Provider Demographics
NPI:1821605528
Name:GARRUTO, JOHN M (DED)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:GARRUTO
Suffix:
Gender:M
Credentials:DED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 BALBOA DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1635
Mailing Address - Country:US
Mailing Address - Phone:315-729-7248
Mailing Address - Fax:
Practice Address - Street 1:7854 OSWEGO RD STE 104
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2137
Practice Address - Country:US
Practice Address - Phone:315-303-3017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022447103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist