MEDICARE: VICTORIA VAN LEEUWEN

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	0906010069	VA

General Provider Information

NPI Number	:	1871167858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA VAN LEEUWEN

Provider Business Mailing Address
First Line	:	25275 KENNEBEC DR
Second Line	:
City	:	SOUTH RIDING
State	:	VA
Zip	:	20152-4468
Country	:	US
Telephone Number	:	703-501-4795
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 S BELL ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-4511
Country	:	US
Telephone Number	:	571-402-5502
Fax Number	:

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

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	05/17/2023

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Directions to “ VICTORIA VAN LEEUWEN ” Practice Location

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