Healthcare Provider Details

I. General information

NPI: 1588742571
Provider Name (Legal Business Name): CANDACE L RUTHERFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 S COLDBROOK AVE UNIT 2
CHAMBERSBURG PA
17201-2714
US

IV. Provider business mailing address

13457 MERCERSBURG RD
GREENCASTLE PA
17225-8636
US

V. Phone/Fax

Practice location:
  • Phone: 717-267-7480
  • Fax: 717-267-7403
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013456
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: