Healthcare Provider Details

I. General information

NPI: 1922199124
Provider Name (Legal Business Name): JOSEPH D CABUSH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 BLENHEIM BLVD STE 43B
FAIRFAX VA
22030-2434
US

IV. Provider business mailing address

4017 WEXFORD DR
KENSINGTON MD
20895-1524
US

V. Phone/Fax

Practice location:
  • Phone: 703-691-0036
  • Fax: 703-691-4009
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003194
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: