Provider Demographics
NPI:1962589796
Name:KAGHAN, ALEXANDRA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:
Last Name:KAGHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CHURCH ST NW
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4434
Mailing Address - Country:US
Mailing Address - Phone:703-319-1436
Mailing Address - Fax:703-938-8393
Practice Address - Street 1:243 CHURCH ST NW
Practice Address - Street 2:SUITE 300A
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4434
Practice Address - Country:US
Practice Address - Phone:703-319-1436
Practice Address - Fax:703-938-8393
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040010751041C0700X
DCLC3011251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
491983Medicare ID - Type Unspecified