Basic Information
| Provider Information | |||||||||
| NPI: | 1306966296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORT | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | CHRANLEY | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3018 JAVIER RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032049100 | ||||||||
| FaxNumber: | 7032049590 | ||||||||
| Practice Location | |||||||||
| Address1: | 3018 JAVIER RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032049100 | ||||||||
| FaxNumber: | 7032049590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 09/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149.012283 | IL | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 0904003888 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LC303410 | DC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 10479 | MD | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.