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NPI Code Detail

MEDICARE: ANNE RUTTER L.I.C.S.W.

MEDICARE: ANNE RUTTER L.I.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker1019738MA

General Provider Information

NPI Number : 1043373269
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNE RUTTER L.I.C.S.W.
Provider Business Mailing Address
First Line : 40 ALVESTON ST
Second Line :
City : JAMAICA PLAIN
State : MA
Zip : 02130-2817
Country : US
Telephone Number : 617-522-5236
Fax Number :
Provider Business Practice Location Address
First Line : 124 HARVARD ST
Second Line :
City : BROOKLINE
State : MA
Zip : 02446-6478
Country : US
Telephone Number : 617-232-4350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/08/2007

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