Provider Demographics
NPI:1831403633
Name:RUTHERFORD, ANN S (LICSW)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:S
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BELMONT ST # 1R
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1511
Mailing Address - Country:US
Mailing Address - Phone:617-501-1004
Mailing Address - Fax:
Practice Address - Street 1:111 BELMONT ST # 1R
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1511
Practice Address - Country:US
Practice Address - Phone:617-501-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1151281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical