Provider Demographics
NPI:1962009803
Name:RUTTER, ERIC MATTHEW (LMFT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MATTHEW
Last Name:RUTTER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BRINSMAYD AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1328
Mailing Address - Country:US
Mailing Address - Phone:203-522-1988
Mailing Address - Fax:
Practice Address - Street 1:125 BRINSMAYD AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1328
Practice Address - Country:US
Practice Address - Phone:203-522-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2472106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist