Healthcare Provider Details

I. General information

NPI: 1760228829
Provider Name (Legal Business Name): MAEVE WILSON BERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 UNIVERSITY DR
FAIRFAX VA
22030-4422
US

IV. Provider business mailing address

8535 HILLTOP RD
VIENNA VA
22180-7075
US

V. Phone/Fax

Practice location:
  • Phone: 703-967-7187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: