MEDICARE: MS. CAROLINE JOYCE CSONGOS LCSW

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	0904004862	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0904004862	OTHER	VA	CLINICAL LICENSE

General Provider Information

NPI Number	:	1831290329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLINE JOYCE CSONGOS LCSW

Provider Business Mailing Address
First Line	:	13575 HEATHCOTE BLVD STE 201
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-6660
Country	:	US
Telephone Number	:	703-289-7560
Fax Number	:	703-289-8710

Provider Business Practice Location Address
First Line	:	13575 HEATHCOTE BLVD STE 201
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-6660
Country	:	US
Telephone Number	:	703-289-7560
Fax Number	:	703-289-8710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	12/12/2019

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