Provider Demographics
NPI:1851449292
Name:RUTHERFORD, AMANDA ELIZABETH (LICSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01521-2027
Mailing Address - Country:US
Mailing Address - Phone:978-337-2504
Mailing Address - Fax:
Practice Address - Street 1:30 PINE TREE DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MA
Practice Address - Zip Code:01521-2027
Practice Address - Country:US
Practice Address - Phone:978-337-2504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1142461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical