Provider Demographics
NPI:1912054123
Name:MERIDIAN THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:MERIDIAN THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-368-3011
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10168Medicare PIN