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NPI Code Detail

MEDICARE: COLLEEN LAGASSE LCSW

MEDICARE:   COLLEEN  LAGASSE  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 Worker0904016466VA

General Provider Information

NPI Number : 1972369791
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN LAGASSE LCSW
Provider Business Mailing Address
First Line : 563 NALLS DAIRY CT
Second Line :
City : GREAT FALLS
State : VA
Zip : 22066-1145
Country : US
Telephone Number : 571-444-3822
Fax Number :
Provider Business Practice Location Address
First Line : 11150 SUNSET HILLS RD STE 150
Second Line :
City : RESTON
State : VA
Zip : 20190-5325
Country : US
Telephone Number : 571-306-0563
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2024
Last Update Date : 02/28/2024

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Directions to “ COLLEEN LAGASSE LCSW” Practice Location

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