Healthcare Provider Details

I. General information

NPI: 1710045331
Provider Name (Legal Business Name): JONATHAN H ZEITLIN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N ST. ASAPH ST.
ALEXANDRIA VA
22314-1941
US

IV. Provider business mailing address

720 N ST. ASAPH ST.
ALEXANDRIA VA
22314-1941
US

V. Phone/Fax

Practice location:
  • Phone: 703-838-4525
  • Fax: 703-838-4254
Mailing address:
  • Phone: 703-838-4525
  • Fax: 703-838-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005084
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00300529
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04242
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: