Provider Demographics
NPI:1124247960
Name:GILL, MAUREEN ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ANNE
Last Name:GILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3819 BEECH DOWN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3348
Mailing Address - Country:US
Mailing Address - Phone:703-803-4051
Mailing Address - Fax:703-689-9781
Practice Address - Street 1:6 PIDGEON HILL DR
Practice Address - Street 2:SUITE 260
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6104
Practice Address - Country:US
Practice Address - Phone:703-803-4051
Practice Address - Fax:703-689-9187
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040054231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
103900OtherANTHEM