Provider Demographics
NPI:1336233154
Name:RUTLEDGE, CHARLENE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:RUTLEDGE
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 1:520 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7420
Mailing Address - Country:US
Mailing Address - Phone:732-966-3209
Mailing Address - Fax:732-244-8077
Practice Address - Street 1:520 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7420
Practice Address - Country:US
Practice Address - Phone:732-330-2817
Practice Address - Fax:732-330-2817
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052424001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical