Provider Demographics
NPI:1912083239
Name:RUTSKY, MONICA POLLIN (LCSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:POLLIN
Last Name:RUTSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 TOTTENHAM PL
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3516
Mailing Address - Country:US
Mailing Address - Phone:516-741-0871
Mailing Address - Fax:
Practice Address - Street 1:37 TOTTENHAM PL
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3516
Practice Address - Country:US
Practice Address - Phone:516-741-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR021631-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPR021631-1OtherSTATE LICENSE