Provider Demographics
NPI:1366580987
Name:WEISBERG, MIRIAM (MSW)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:WEISBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5704
Mailing Address - Country:US
Mailing Address - Phone:703-298-0631
Mailing Address - Fax:703-790-0245
Practice Address - Street 1:1499 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5704
Practice Address - Country:US
Practice Address - Phone:703-298-0631
Practice Address - Fax:703-790-0245
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040043901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA60000001OtherBLUE CROSS BLUE SHIELD