Healthcare Provider Details

I. General information

NPI: 1265191654
Provider Name (Legal Business Name): OLGA V ZURITA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 WESTWOOD CENTER DRIVE SUITE 110 PMB 1039
VIENNA VA
22182
US

IV. Provider business mailing address

8221 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4512
US

V. Phone/Fax

Practice location:
  • Phone: 703-239-3737
  • Fax:
Mailing address:
  • Phone: 703-239-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013370
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: