Provider Demographics
NPI:1487062683
Name:RUTLEDGE, MARJIE
Entity type:Individual
Prefix:MISS
First Name:MARJIE
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 HOSPITAL DR
Mailing Address - Street 2:025
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1194
Mailing Address - Country:US
Mailing Address - Phone:301-583-3798
Mailing Address - Fax:
Practice Address - Street 1:3003 HOSPITAL DR
Practice Address - Street 2:025
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1194
Practice Address - Country:US
Practice Address - Phone:301-583-3798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17574104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker