Provider Demographics
NPI:1295950426
Name:JUTKOWITZ, MONICA REGINA (MSW)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:REGINA
Last Name:JUTKOWITZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 LAURANCE AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1921
Mailing Address - Country:US
Mailing Address - Phone:215-732-1650
Mailing Address - Fax:215-886-4251
Practice Address - Street 1:1528 WALNUT ST
Practice Address - Street 2:SUITE 705
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3604
Practice Address - Country:US
Practice Address - Phone:215-732-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0129061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical