1821317850 NPI number — MRS. LAURA G. CLEMENT LCSW, LCSW-C, LICSW

Table of content: MRS. LAURA G. CLEMENT LCSW, LCSW-C, LICSW (NPI 1821317850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821317850 NPI number — MRS. LAURA G. CLEMENT LCSW, LCSW-C, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEMENT
Provider First Name:
LAURA
Provider Middle Name:
G.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LCSW-C, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILMOUR
Provider Other First Name:
LAURA
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LGSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821317850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4740 CONNECTICUT AVE NW
Provider Second Line Business Mailing Address:
APT. 504
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20008-5628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-876-0643
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1495 CHAIN BRIDGE RD
Provider Second Line Business Practice Location Address:
WEAVER AND ASSOCIATES, PLLC, STE 300
Provider Business Practice Location Address City Name:
MC LEAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22101-5727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-577-6836
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2010

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:  0904007711 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 17180 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LC50079108 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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