Healthcare Provider Details

I. General information

NPI: 1760508345
Provider Name (Legal Business Name): MARTHA BOBINSKI RAPP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5999 BURKE COMMONS RD
BURKE VA
22015-2880
US

IV. Provider business mailing address

2101 EAST JEFFERSON STREET KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 703-249-7700
  • Fax: 703-249-7266
Mailing address:
  • Phone: 301-816-7405
  • Fax: 301-388-1740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0904003751
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: