Healthcare Provider Details

I. General information

NPI: 1902410400
Provider Name (Legal Business Name): LIBBY TOFFLEMIRE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BOROUGHBRIDGE RD
RICHMOND VA
23225-6218
US

IV. Provider business mailing address

601 BOROUGHBRIDGE RD
RICHMOND VA
23225-6218
US

V. Phone/Fax

Practice location:
  • Phone: 605-354-6134
  • Fax:
Mailing address:
  • Phone: 605-354-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904011479
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: