1194991547 NPI number — MS. INTA A RUTINS MSW LCSW LICSW

Table of content: MS. INTA A RUTINS MSW LCSW LICSW (NPI 1194991547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194991547 NPI number — MS. INTA A RUTINS MSW LCSW LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTINS
Provider First Name:
INTA
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADANIOVICS
Provider Other First Name:
INTA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LCSW LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194991547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 LADD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902-3518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-649-3135
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 FOREST GLEN ROAD
Provider Second Line Business Practice Location Address:
HOLY CROSS HOSPITAL
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20910-1484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-754-7866
Provider Business Practice Location Address Fax Number:
301-754-7504
Provider Enumeration Date:
05/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  01989 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: LC0301322 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 410176600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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