Provider Demographics
NPI:1154488302
Name:HRUSKA, LEO GEORGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:GEORGE
Last Name:HRUSKA
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 1:716 GIDDINGS AVE
Mailing Address - Street 2:SUITE 33
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1408
Mailing Address - Country:US
Mailing Address - Phone:410-268-8590
Mailing Address - Fax:
Practice Address - Street 1:716 GIDDINGS AVE
Practice Address - Street 2:SUITE 33
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1408
Practice Address - Country:US
Practice Address - Phone:410-268-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical