Provider Demographics
NPI:1215955836
Name:ROTHER, ROBERT G (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:G
Last Name:ROTHER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 HUNTER VIEW FARMS
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1552
Mailing Address - Country:US
Mailing Address - Phone:571-437-5455
Mailing Address - Fax:
Practice Address - Street 1:11260 ROGER BACON DR
Practice Address - Street 2:# 500
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5227
Practice Address - Country:US
Practice Address - Phone:571-437-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040045261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0007466396OtherAETNA
VA0904004526OtherLCSW DEPT OF HEALTH PROFF