Provider Demographics
NPI:1205924602
Name:RUTHERFORD, DAVID FORREST (LCSWC MSSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:FORREST
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:LCSWC MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 PROFESSIONAL COURT
Mailing Address - Street 2:MENTAL HEALTH CENTER
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:301-791-3405
Mailing Address - Fax:301-714-1212
Practice Address - Street 1:1180 PROFESSIONAL COURT
Practice Address - Street 2:THE MENTAL HEALTH CENTER OF WESTERN MARYLAND INC
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740
Practice Address - Country:US
Practice Address - Phone:301-791-3405
Practice Address - Fax:240-313-3071
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04938104100000X
PACW013713104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker