=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215227400
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURIE ANN WEISS-BRAUNSTEIN L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2011
-----------------------------------------------------
Last Update Date | 03/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10900 UNIVERSITY BLVD BULL RUN HALL, SUITE 147
-----------------------------------------------------
City | MANASSAS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20110-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-447-8056
-----------------------------------------------------
Fax | 703-993-8631
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10900 UNIVERSITY BLVD, BULL RUN HALL SUITE 147
-----------------------------------------------------
City | MANASSAS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20110-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-447-8056
-----------------------------------------------------
Fax | 703-993-8631
-----------------------------------------------------
=====================================================
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 | 0904004475
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------