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General NPI Number Information
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NPI Number | 1851500151
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Entity Type | Organization
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Legal Business Name | DANIEL RUTRICK MD PC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 617 BROADWAY
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City | EVERETT
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State | MA
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Zip | 02149-3712
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Country | US
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Telephone | 617-387-2220
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Fax | 617-394-0538
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Provider Business Mailing Address
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Address Line | 617 BROADWAY
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City | EVERETT
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State | MA
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Zip | 02149-3712
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Country | US
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Telephone | 617-387-2220
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Fax | 617-394-0538
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | EILEEN MCCLELLAN
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Credential | OFFICE MANAGER
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Telephone | 617-387-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 36462
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2351
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 8277
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 142070
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 164216
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License Number State | MA
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