Healthcare Provider Details

I. General information

NPI: 1396551982
Provider Name (Legal Business Name): MADILYNN RUTHERFORD MED, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CONZ ST STE 101
NORTHAMPTON MA
01060-3881
US

IV. Provider business mailing address

882 LEE RD
GUILFORD VT
05301-8594
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-0265
  • Fax:
Mailing address:
  • Phone: 832-671-9752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001297
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: