Healthcare Provider Details

I. General information

NPI: 1710175187
Provider Name (Legal Business Name): NINA ROBIN SAX-MOORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CAMERON GLEN DR SUITE # 600
RESTON VA
20190-3363
US

IV. Provider business mailing address

1850 CAMERON GLEN DR SUITE # 600
RESTON VA
20190-3363
US

V. Phone/Fax

Practice location:
  • Phone: 703-481-4234
  • Fax: 703-435-1961
Mailing address:
  • Phone: 703-481-4234
  • Fax: 703-435-1961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006685
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: