Healthcare Provider Details

I. General information

NPI: 1184127730
Provider Name (Legal Business Name): JOSEPH ERNEST MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BRADDOCK PL
ALEXANDRIA VA
22314-1693
US

IV. Provider business mailing address

1340 BRADDOCK PL
ALEXANDRIA VA
22314-1693
US

V. Phone/Fax

Practice location:
  • Phone: 703-824-6731
  • Fax:
Mailing address:
  • Phone: 703-824-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: