Healthcare Provider Details

I. General information

NPI: 1164634796
Provider Name (Legal Business Name): VERONICA MAUREEN JANER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 CHAIN BRIDGE RD SUITE C
FAIRFAX VA
22030-3246
US

IV. Provider business mailing address

3611 CHAIN BRIDGE RD SUITE C
FAIRFAX VA
22030-3246
US

V. Phone/Fax

Practice location:
  • Phone: 703-568-1851
  • Fax: 703-261-6980
Mailing address:
  • Phone: 703-568-1851
  • Fax: 703-261-6980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006544
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: