Healthcare Provider Details

I. General information

NPI: 1356431084
Provider Name (Legal Business Name): AMY BAINES ROBINSON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 BROOKFIELD CORPORATE DR C/O FOR CHILDREN'S SAKE OF VIRGINIA - EDC
CHANTILLY VA
20151-1670
US

IV. Provider business mailing address

4455 BROOKFIELD CORPORATE DR C/O FOR CHILDREN'S SAKE OF VIRGINIA - EDC
CHANTILLY VA
20151-1670
US

V. Phone/Fax

Practice location:
  • Phone: 703-817-9890
  • Fax:
Mailing address:
  • Phone: 703-817-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006268
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: