Provider Demographics
NPI:1629028758
Name:RUTSKY, ROBIN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:RUTSKY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 PRINCESS ANNE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3254
Mailing Address - Country:US
Mailing Address - Phone:540-368-3011
Mailing Address - Fax:540-368-1000
Practice Address - Street 1:2601 PRINCESS ANNE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3254
Practice Address - Country:US
Practice Address - Phone:540-368-3011
Practice Address - Fax:540-368-1000
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040040301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA249791OtherANTHEM BC/BS OF VA
VA249791OtherANTHEM BC/BS OF VA
VAS84689Medicare UPIN