Healthcare Provider Details

I. General information

NPI: 1487027850
Provider Name (Legal Business Name): MRS. DENISE MARCONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2015
Last Update Date: 11/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

14048 EAGLE CHASE CIR
CHANTILLY VA
20151-2238
US

V. Phone/Fax

Practice location:
  • Phone: 703-380-9045
  • Fax:
Mailing address:
  • Phone: 703-830-8773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26-4621538
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: