Provider Demographics
NPI:1992152391
Name:RUTT, BENJAMIN (PHD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:RUTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 KEY HWY
Mailing Address - Street 2:STE 300M
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5189
Mailing Address - Country:US
Mailing Address - Phone:410-995-8219
Mailing Address - Fax:
Practice Address - Street 1:1414 KEY HWY
Practice Address - Street 2:STE 300M
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5189
Practice Address - Country:US
Practice Address - Phone:410-995-8219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05682103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling