Fahey, Mary Lou

Fahey, Mary Lou is an sole proprietor health care provider with primary practice located at 7969 Ashton Ave , Manassas VA 20109-2885. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Fahey, Mary Lou can be contacted via phone (703) 792-7800.

Contact Information

Primary practice address
7969 Ashton Ave Manassas VA 20109-2885
Phone: (703) 792-7800
Fax: (703) 792-5699
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 0904004560 Virginia

Profile Details

NPI number 1063537595
LBN Legal business name Fahey, Mary Lou
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 21st, 2007
Last updated Jan 17th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063537595 NPPES
Virginia Other 292737 AMERIGROUP
Virginia MEDICAID 4945247 AMERIGROUP
Virginia Other 245421 AMERIGROUP

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