Healthcare Provider Details

I. General information

NPI: 1477887701
Provider Name (Legal Business Name): CARLA SUAREZ BATENGA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25467 VACATION PL
ALDIE VA
20105-3417
US

IV. Provider business mailing address

25467 VACATION PL
ALDIE VA
20105-3417
US

V. Phone/Fax

Practice location:
  • Phone: 703-405-3228
  • Fax: 703-327-8098
Mailing address:
  • Phone: 703-405-3228
  • Fax: 703-327-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13208-C
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31901
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007682
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: