MEDICARE: BRIAN J DOUVILLE 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
1	1041C0700X	Clinical Social Worker	0904003005	VA

General Provider Information

NPI Number	:	1568678704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN J DOUVILLE LCSW

Provider Business Mailing Address
First Line	:	4641 MAYHUNT CT
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-1307
Country	:	US
Telephone Number	:	703-615-0763
Fax Number	:

Provider Business Practice Location Address
First Line	:	4641 MAYHUNT COURT
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312
Country	:	US
Telephone Number	:	703-550-4048
Fax Number	:	703-534-7163

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	02/03/2026

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