Healthcare Provider Details

I. General information

NPI: 1568558450
Provider Name (Legal Business Name): LAURIE LERNER ROSEN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10470 ARMSTRONG ST COUNSELING CENTER OF FAIRFAX
FAIRFAX VA
22030-3648
US

IV. Provider business mailing address

10609 BATTALION LANDING CT
BURKE VA
22015-2517
US

V. Phone/Fax

Practice location:
  • Phone: 703-239-2600
  • Fax: 703-385-7578
Mailing address:
  • Phone: 703-321-0098
  • Fax: 703-239-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002946
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: