Provider Demographics
NPI:1316953508
Name:SMOLEN, GERALD (LCSW-C)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:SMOLEN
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9306 CORONADO TER
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3835
Mailing Address - Country:US
Mailing Address - Phone:703-218-8457
Mailing Address - Fax:
Practice Address - Street 1:5045 BACKLICK ROAD
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22032
Practice Address - Country:US
Practice Address - Phone:703-914-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040018671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical