Healthcare Provider Details

I. General information

NPI: 1730807041
Provider Name (Legal Business Name): JOSEPH ROBERT AARON FRUTH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4512
US

IV. Provider business mailing address

205 VAN BUREN STREET SUITE 120 1028
HERNDON VA
20170
US

V. Phone/Fax

Practice location:
  • Phone: 571-536-8040
  • Fax: 703-653-7002
Mailing address:
  • Phone: 301-893-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013739
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: