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NPI Code Detail

MEDICARE: MS. MARINA RENEE RUTKOWSKI LCSW-C

MEDICARE: MS. MARINA RENEE RUTKOWSKI LCSW-C
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
1104100000XSocial WorkerASW 20571CA
21041C0700XClinical Social WorkerCW016449PA
31041C0700XClinical Social Worker149013295IL
41041C0700XClinical Social WorkerCSW004620GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326261645
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARINA RENEE RUTKOWSKI LCSW-C
Provider Business Mailing Address
First Line : 903 ADANA RD STE D3
Second Line :
City : PIKESVILLE
State : MD
Zip : 21208-4745
Country : US
Telephone Number : 317-313-0240
Fax Number :
Provider Business Practice Location Address
First Line : 1009 FREDERICK RD
Second Line :
City : CATONSVILLE
State : MD
Zip : 21228-5055
Country : US
Telephone Number : 440-467-0648
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2007
Last Update Date : 11/24/2020

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