Provider Demographics
NPI:1992786065
Name:SHROUT, CATHERINE ANN (LCSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:SHROUT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W CRISER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2360
Mailing Address - Country:US
Mailing Address - Phone:540-636-4592
Mailing Address - Fax:540-636-8161
Practice Address - Street 1:209 W CRISER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2360
Practice Address - Country:US
Practice Address - Phone:540-636-4592
Practice Address - Fax:540-636-8161
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040043741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA800002935Medicare ID - Type Unspecified
P52891Medicare UPIN