1740263342 NPI number — MS. ELIZABETH ANNE HEALY LCSW, CAC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740263342 NPI number — MS. ELIZABETH ANNE HEALY LCSW, CAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEALY
Provider First Name:
ELIZABETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEALY
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW, ADC, CCDP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740263342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6208 OLD FRANCONIA RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22310-3406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-203-2385
Provider Business Mailing Address Fax Number:
703-778-1069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6208 OLD FRANCONIA RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22310-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-203-2385
Provider Business Practice Location Address Fax Number:
703-778-1069
Provider Enumeration Date:
11/29/2005

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: 101YA0400X , with the licence number:  89211 , 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: 0904004910 , 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)

  • Identifier: 0904004910 . This is a "LICENSED CLINICAL SOCIAL WORKER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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