Provider Demographics
NPI:1144553918
Name:RUTLEDGE, DEBORAH ROSE (MFTI)
Entity type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:ROSE
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-2270
Mailing Address - Country:US
Mailing Address - Phone:415-640-2097
Mailing Address - Fax:
Practice Address - Street 1:2780 JUNIPERO SERRA BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1634
Practice Address - Country:US
Practice Address - Phone:650-985-7016
Practice Address - Fax:650-985-7019
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 57586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA943083772OtherJEFFERSON UNION HIGH SCHOOL DISTRICT