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NPI Code Detail

MEDICARE: ANGELA CAPPUCCILLI GANNON LCSW

MEDICARE: ANGELA CAPPUCCILLI GANNON LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker1647VA

General Provider Information

NPI Number : 1063751782
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA CAPPUCCILLI GANNON LCSW
Provider Business Mailing Address
First Line : 7010 BRADDOCK RD
Second Line :
City : ANNANDALE
State : VA
Zip : 22003-6006
Country : US
Telephone Number : 703-941-8810
Fax Number : 703-658-2378
Provider Business Practice Location Address
First Line : 7010 BRADDOCK RD
Second Line :
City : ANNANDALE
State : VA
Zip : 22003-6006
Country : US
Telephone Number : 703-941-8810
Fax Number : 703-658-2378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2013
Last Update Date : 02/01/2013

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Directions to “ ANGELA CAPPUCCILLI GANNON LCSW” Practice Location

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