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General NPI Number Information
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NPI Number | 1326261645
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Entity Type | Individual
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Provider Name | MARINA RENEE RUTKOWSKI LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 1009 FREDERICK RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-5055
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Country | US
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Telephone | 440-467-0648
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Fax |
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Provider Business Mailing Address
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Address Line | 903 ADANA RD STE D3
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City | PIKESVILLE
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State | MD
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Zip | 21208-4745
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Country | US
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Telephone | 317-313-0240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW 20571
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW016449
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149013295
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004620
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License Number State | GA
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