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NPI Code Detail

MEDICARE: MS. ANN THERESA CUEBAS LICSW, LCSW

MEDICARE: MS. ANN THERESA CUEBAS LICSW, 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 Worker0904008514VA
21041C0700XClinical Social WorkerLC50078812DC

General Provider Information

NPI Number : 1912203803
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANN THERESA CUEBAS LICSW, LCSW
Provider Business Mailing Address
First Line : 5415 INVERCHAPEL RD
Second Line :
City : SPRINGFIELD
State : VA
Zip : 22151-2019
Country : US
Telephone Number : 202-319-2257
Fax Number : 202-332-5442
Provider Business Practice Location Address
First Line : 1419 COLUMBIA RD NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20009-4705
Country : US
Telephone Number : 202-319-2257
Fax Number : 202-332-5442
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2011
Last Update Date : 06/01/2021

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