Provider Demographics
NPI:1194991547
Name:RUTINS, INTA A (MSW LCSW LICSW)
Entity type:Individual
Prefix:MS
First Name:INTA
Middle Name:A
Last Name:RUTINS
Suffix:
Gender:F
Credentials:MSW LCSW LICSW
Other - Prefix:MS
Other - First Name:INTA
Other - Middle Name:
Other - Last Name:ADANIOVICS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW LICSW
Mailing Address - Street 1:1501 LADD STREET
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3518
Mailing Address - Country:US
Mailing Address - Phone:301-649-3135
Mailing Address - Fax:
Practice Address - Street 1:1500 FOREST GLEN ROAD
Practice Address - Street 2:HOLY CROSS HOSPITAL
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1484
Practice Address - Country:US
Practice Address - Phone:301-754-7866
Practice Address - Fax:301-754-7504
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD019891041C0700X
DCLC03013221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410176600Medicaid
MD410176600Medicaid