MEDICARE: DEBRA L. TIEVSKY, LCSW, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904001786	VA

General Provider Information

NPI Number	:	1760582340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA L. TIEVSKY, LCSW, PC

Provider Business Mailing Address
First Line	:	5675 STONE RD
Second Line	:	STE 300
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-1667
Country	:	US
Telephone Number	:	703-715-6011
Fax Number	:	703-991-9127

Provider Business Practice Location Address
First Line	:	5675 STONE RD
Second Line	:	STE 300
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-1667
Country	:	US
Telephone Number	:	703-715-6011
Fax Number	:	703-991-9127

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. DEBRA LEE TIEVSKY
Credential	:	LCSW
Telephone Number	:	703-715-6011

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	04/14/2010

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