Individual
MR. CARLICE CECIL RUTTAN II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
165 COLEMAN AVE, WATERTOWN, NY 13601-2217
(315) 782-2061
(315) 788-1529
Mailing address
165 COLEMAN AVE, WATERTOWN, NY 13601-2217
(315) 782-2061
(315) 788-1529
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
079048-1
NY
Other
Enumeration date
05/21/2012
Last updated
05/21/2012
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