1205924602 NPI number — DAVID FORREST RUTHERFORD LCSWC MSSW

Table of content: DAVID FORREST RUTHERFORD LCSWC MSSW (NPI 1205924602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205924602 NPI number — DAVID FORREST RUTHERFORD LCSWC MSSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTHERFORD
Provider First Name:
DAVID
Provider Middle Name:
FORREST
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSWC MSSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205924602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1180 PROFESSIONAL COURT
Provider Second Line Business Mailing Address:
MENTAL HEALTH CENTER
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-791-3405
Provider Business Mailing Address Fax Number:
301-714-1212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 PROFESSIONAL COURT
Provider Second Line Business Practice Location Address:
THE MENTAL HEALTH CENTER OF WESTERN MARYLAND INC
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-791-3405
Provider Business Practice Location Address Fax Number:
240-313-3071
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  04938 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: CW013713 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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