Healthcare Provider Details

I. General information

NPI: 1275968190
Provider Name (Legal Business Name): DORITH PRUTCHI MSS, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S BROADWAY #7
PITMAN NJ
08071-2235
US

IV. Provider business mailing address

525 ROUTE 73 N SUITE 104
MARLTON NJ
08053-3422
US

V. Phone/Fax

Practice location:
  • Phone: 844-365-7676
  • Fax: 844-365-7676
Mailing address:
  • Phone: 609-510-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05551500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: