Provider Demographics
NPI:1033120951
Name:FREUD, RUTH A (LCSW, PSYD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:A
Last Name:FREUD
Suffix:
Gender:F
Credentials:LCSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11260 ROGER BACON DR STE 204
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5252
Mailing Address - Country:US
Mailing Address - Phone:703-435-7558
Mailing Address - Fax:571-446-3988
Practice Address - Street 1:11260 ROGER BACON DR STE 204
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5252
Practice Address - Country:US
Practice Address - Phone:703-435-7558
Practice Address - Fax:571-446-3988
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904001797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA89-0436-7Medicaid
VA89-0436-7Medicaid