Healthcare Provider Details

I. General information

NPI: 1841287877
Provider Name (Legal Business Name): SARA MARIE RUTAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 VONDERBURG DR STE 301
BRANDON FL
33511-6072
US

IV. Provider business mailing address

510 VONDERBURG DR STE 301
BRANDON FL
33511-6072
US

V. Phone/Fax

Practice location:
  • Phone: 813-881-1000
  • Fax: 417-269-7212
Mailing address:
  • Phone: 813-881-1000
  • Fax: 417-269-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: