Healthcare Provider Details

I. General information

NPI: 1942653134
Provider Name (Legal Business Name): ADENA LEVY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WOOD HILL RD ATTN: JACQUELYN RICE
ROCKVILLE MD
20850-8724
US

IV. Provider business mailing address

3018 JAVIER RD
FAIRFAX VA
22031-4609
US

V. Phone/Fax

Practice location:
  • Phone: 301-610-8306
  • Fax:
Mailing address:
  • Phone: 703-204-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0904009293
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: