=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255432712
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARCIE ELLEN SOLOMON MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 11/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 WILSON BLVD SUITE 702
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22209-2511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-522-9053
-----------------------------------------------------
Fax | 703-525-5643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 WILSON BLVD SUITE 702
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22209-2511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-522-9053
-----------------------------------------------------
Fax | 703-525-5643
-----------------------------------------------------
=====================================================
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 | 0904000303
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------