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General NPI Number Information
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NPI Number | 1467659169
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Entity Type | Individual
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Provider Name | MARYANN GASAWAY LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7330 MCWHORTER PL
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City | ANNANDALE
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State | VA
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Zip | 22003-5605
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Country | US
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Telephone | 703-323-8845
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Fax |
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Provider Business Mailing Address
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Address Line | 5421 AYLOR RD
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City | FAIRFAX
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State | VA
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Zip | 22032-3804
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Country | US
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Telephone | 703-323-0671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0904000455
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License Number State | VA
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