Healthcare Provider Details

I. General information

NPI: 1770507097
Provider Name (Legal Business Name): BARRY LEONARD LOSS L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN SUITE 400
SPRINGFIELD VA
22152-1663
US

IV. Provider business mailing address

8348 TRAFORD LN SUITE 400
SPRINGFIELD VA
22152-1663
US

V. Phone/Fax

Practice location:
  • Phone: 703-866-2115
  • Fax: 703-451-7539
Mailing address:
  • Phone: 703-866-2115
  • Fax: 703-451-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001382
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: