Provider Demographics
NPI:1982725685
Name:RUTKOWSKI, NICHOLAS JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JAMES
Last Name:RUTKOWSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 MADONNA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6620
Mailing Address - Country:US
Mailing Address - Phone:210-377-1133
Mailing Address - Fax:210-377-1230
Practice Address - Street 1:7711 MADONNA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6620
Practice Address - Country:US
Practice Address - Phone:210-377-1133
Practice Address - Fax:210-377-1230
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00237352OtherRUTKOWSKI
TX143544801Medicaid
TX86499QOtherRUTKOWSKI
TXP00237352OtherRUTKOWSKI