Healthcare Provider Details

I. General information

NPI: 1851500151
Provider Name (Legal Business Name): DANIEL RUTRICK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BROADWAY
EVERETT MA
02149-3712
US

IV. Provider business mailing address

617 BROADWAY
EVERETT MA
02149-3712
US

V. Phone/Fax

Practice location:
  • Phone: 617-387-2220
  • Fax: 617-394-0538
Mailing address:
  • Phone: 617-387-2220
  • Fax: 617-394-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2351
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8277
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number142070
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number164216
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number36462
License Number StateMA

VIII. Authorized Official

Name: EILEEN MCCLELLAN
Title or Position: OFFICE MANGER
Credential: OFFICE MANAGER
Phone: 617-387-2220