Provider Demographics
NPI:1013116664
Name:RUTKOVSKY, CAROLE (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:RUTKOVSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2289 CROYDON DR
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3046
Mailing Address - Country:US
Mailing Address - Phone:516-382-3733
Mailing Address - Fax:
Practice Address - Street 1:220 PETTIT AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3629
Practice Address - Country:US
Practice Address - Phone:516-382-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical