Provider Demographics
NPI:1316510902
Name:RUTHKOSKY, SAMANTHA FRANCIE (LMSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:FRANCIE
Last Name:RUTHKOSKY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GLEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6505
Mailing Address - Country:US
Mailing Address - Phone:184-524-2747
Mailing Address - Fax:
Practice Address - Street 1:11 GLEN RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6505
Practice Address - Country:US
Practice Address - Phone:184-524-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092428-011041C0700X
NY105915-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker