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General NPI Number Information
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NPI Number | 1285955021
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Entity Type | Organization
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Legal Business Name | ELAINE P. BOOMER PC
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 501 CHURCH ST NE SUITE 206
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City | VIENNA
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State | VA
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Zip | 22180-4734
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Country | US
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Telephone | 703-255-2208
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Fax | 703-255-2482
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Provider Business Mailing Address
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Address Line | 501 CHURCH ST NE SUITE 206
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City | VIENNA
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State | VA
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Zip | 22180-4734
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Country | US
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Telephone | 703-255-2208
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Fax | 703-255-2482
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ELAINE P BOOMER
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Credential | LCSW
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Telephone | 703-255-2208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904003838
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License Number State | VA
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