Healthcare Provider Details

I. General information

NPI: 1194931485
Provider Name (Legal Business Name): SHERRY A CUPAC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 HERNDON PKWY SUITE 150
HERNDON VA
20170-5286
US

IV. Provider business mailing address

560 HERNDON PKWY SUITE 150
HERNDON VA
20170-5286
US

V. Phone/Fax

Practice location:
  • Phone: 703-856-5595
  • Fax:
Mailing address:
  • Phone: 703-856-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004436
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: