Healthcare Provider Details

I. General information

NPI: 1912928300
Provider Name (Legal Business Name): MS. SUSAN B. ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 HUNTER MILL RD STE 14
OAKTON VA
22124-1716
US

IV. Provider business mailing address

3014 ROSE CREEK CT PO BOX 177
OAKTON VA
22124-1782
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-5547
  • Fax: 703-938-7624
Mailing address:
  • Phone: 703-938-5547
  • Fax: 703-938-7624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001970
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: