Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 0904006961 | VA |
N | 1041C0700X | Clinical Social Worker | LCS22881 | CA |
NPI | 1003069675 |
---|---|
Provider Name | Steven E Frutos |
First Address | Alexandria, VA 22312-1104 |
Second Address | Alexandria, VA 22314-1912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 28/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004945026 | (05) | VA |