MEDICARE: MRS. DAWN M RUTIGLIANO ASW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	1041C0700X	Clinical Social Worker	ASW26922	CA
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1538306626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN M RUTIGLIANO ASW

Provider Business Mailing Address
First Line	:	14725 HYDRANGEA WAY
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91387-1531
Country	:	US
Telephone Number	:	818-980-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-3155
Country	:	US
Telephone Number	:	818-980-3200
Fax Number	:	818-980-3203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	06/14/2013

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