1619034956 NPI number — MRS. MARGAUX RENE PENLAND LCSW

Table of content: MRS. MARGAUX RENE PENLAND LCSW (NPI 1619034956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619034956 NPI number — MRS. MARGAUX RENE PENLAND LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENLAND
Provider First Name:
MARGAUX
Provider Middle Name:
RENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAFORTUNE
Provider Other First Name:
MARGAUX
Provider Other Middle Name:
RENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619034956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 PLEASANT ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22180-5618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-774-7412
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 GALLOWS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22042-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-766-6563
Provider Business Practice Location Address Fax Number:
703-776-7113
Provider Enumeration Date:
01/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0903001406 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 0904006449 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)