Provider Demographics
NPI:1063261113
Name:KRUTIS, SUSAN DENISE (SCD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENISE
Last Name:KRUTIS
Suffix:
Gender:F
Credentials:SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18597 MONTAGUE PL
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3982
Mailing Address - Country:US
Mailing Address - Phone:443-340-2312
Mailing Address - Fax:
Practice Address - Street 1:700 TOLL HOUSE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4516
Practice Address - Country:US
Practice Address - Phone:301-663-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005979225XM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health