=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073655098
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY ELLEN REDER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 11/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 1/2 N WASHINGTON ST
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22314-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-683-2602
-----------------------------------------------------
Fax | 703-683-2602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 1/2 N WASHINGTON ST
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22314-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-683-2602
-----------------------------------------------------
Fax | 703-683-2602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904003270
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------