Healthcare Provider Details

I. General information

NPI: 1326102401
Provider Name (Legal Business Name): RUTH ALICE SIMMONS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 01/03/2012
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 PPQA MEDICARE COMPLIANCE UNIT 6 WEST
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-249-7225
  • Fax: 703-249-7250
Mailing address:
  • Phone: 301-816-2424
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004384
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: