Provider Demographics
NPI:1295800811
Name:RUTAR, STACIE HOPE (MSW,CSW,LISW, LCSW)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:HOPE
Last Name:RUTAR
Suffix:
Gender:F
Credentials:MSW,CSW,LISW, LCSW
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:HOPE
Other - Last Name:CAHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:503 FARRELL DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3775
Mailing Address - Country:US
Mailing Address - Phone:859-331-3292
Mailing Address - Fax:859-578-2864
Practice Address - Street 1:503 FARRELL DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3775
Practice Address - Country:US
Practice Address - Phone:859-331-3292
Practice Address - Fax:859-578-2864
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherGROUP TAX ID NUMBER