1245209964 NPI number — MRS. SARAH ELIZABETH VONHARTEN LCSW

Table of content: MRS. SARAH ELIZABETH VONHARTEN LCSW (NPI 1245209964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245209964 NPI number — MRS. SARAH ELIZABETH VONHARTEN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VONHARTEN
Provider First Name:
SARAH
Provider Middle Name:
ELIZABETH
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245209964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 598
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCCOQUAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22125-0598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-490-9680
Provider Business Mailing Address Fax Number:
703-490-9682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 MILL STREET
Provider Second Line Business Practice Location Address:
UNIT 1A
Provider Business Practice Location Address City Name:
OCCOQUAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-490-9680
Provider Business Practice Location Address Fax Number:
703-490-9682
Provider Enumeration Date:
03/15/2006

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: 1041C0700X , with the licence number:  0904005714 , 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)





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