Healthcare Provider Details

I. General information

NPI: 1518413723
Provider Name (Legal Business Name): MEREDITH RAE CUDDY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 FETTLER PARK DR FL 3
DUMFRIES VA
22025-2050
US

IV. Provider business mailing address

3700 FETTLER PARK DR FL 3
DUMFRIES VA
22025-2050
US

V. Phone/Fax

Practice location:
  • Phone: 703-441-7683
  • Fax:
Mailing address:
  • Phone: 703-441-7683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009269
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: