Healthcare Provider Details

I. General information

NPI: 1104023811
Provider Name (Legal Business Name): NANETTE M HOBACK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7502 DIPLOMAT DR SUITE 101
MANASSAS VA
20109-2631
US

IV. Provider business mailing address

13808 MIKEN CT
MANASSAS VA
20112-3743
US

V. Phone/Fax

Practice location:
  • Phone: 703-401-5875
  • Fax: 703-791-9974
Mailing address:
  • Phone: 703-791-6092
  • Fax: 703-791-9974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002586
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: