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General NPI Number Information
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NPI Number | 1639898323
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Entity Type | Individual
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Provider Name | KELLY ANNE ZUPANCIC LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/25/2022
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 9300 DEWITT LOOP FL 2
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City | FORT BELVOIR
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State | VA
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Zip | 22060-5285
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Country | US
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Telephone | 571-231-1307
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Fax |
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Provider Business Mailing Address
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Address Line | 8633 EAGLE GLEN TER
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-2679
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Country | US
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Telephone | 215-990-5181
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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 | 0904014072
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License Number State | VA
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