Healthcare Provider Details

I. General information

NPI: 1194358564
Provider Name (Legal Business Name): MARIE RENEE REIMANN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210B COMMERCE ST
OCCOQUAN VA
22125-7707
US

IV. Provider business mailing address

4423 FOREST HILL DR
FAIRFAX VA
22030-5601
US

V. Phone/Fax

Practice location:
  • Phone: 703-344-4796
  • Fax:
Mailing address:
  • Phone: 703-344-4796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010613
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: