Healthcare Provider Details

I. General information

NPI: 1235113416
Provider Name (Legal Business Name): DAVID LEONARD TRAUTMANN L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 09/27/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 CHAIN BRIDGE RD. STE 304-A
MCLEAN VA
22101-4501
US

IV. Provider business mailing address

7357 NICOLE MARIE CT
MC LEAN VA
22101-2730
US

V. Phone/Fax

Practice location:
  • Phone: 703-634-9893
  • Fax:
Mailing address:
  • Phone: 571-655-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-3971
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: