Healthcare Provider Details

I. General information

NPI: 1558222927
Provider Name (Legal Business Name): JOSEPH FRUTH, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 VAN BUREN ST STE 120
HERNDON VA
20170-5336
US

IV. Provider business mailing address

205 VAN BUREN STREET SUITE 120 #1028
HERNDON VA
20170
US

V. Phone/Fax

Practice location:
  • Phone: 301-893-4486
  • Fax:
Mailing address:
  • Phone: 301-893-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JOSEPH FRUTH
Title or Position: OWNER
Credential: LCSW
Phone: 301-893-4486