Provider Demographics
NPI:1912353236
Name:RUTHERFORD, DAVID MARK II (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARK
Last Name:RUTHERFORD
Suffix:II
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7926 110TH AVE SE APT 1304
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1691
Mailing Address - Country:US
Mailing Address - Phone:206-702-8191
Mailing Address - Fax:
Practice Address - Street 1:305 S LUCILE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2435
Practice Address - Country:US
Practice Address - Phone:206-764-5149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW612632091041C0700X
AL4086C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical