Provider Demographics
NPI:1548550270
Name:RUTHERFORD, MARK D (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-7726
Mailing Address - Country:US
Mailing Address - Phone:561-835-6821
Mailing Address - Fax:561-835-6742
Practice Address - Street 1:1900 S OLIVE AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7726
Practice Address - Country:US
Practice Address - Phone:561-835-6821
Practice Address - Fax:561-835-6742
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW55771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical