Basic Information
| Provider Information | |||||||||
| NPI: | 1669588109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHWARTZ | ||||||||
| FirstName: | ELLIOTT | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5630 RAPID RUN CT | ||||||||
| Address2: | |||||||||
| City: | BURKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220151800 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3018 JAVIER RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032049100 | ||||||||
| FaxNumber: | 7032049590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904004576 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.