Provider Demographics
NPI:1043220841
Name:WEISSHAAR, PAULA S (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:S
Last Name:WEISSHAAR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 ROUND TABLE CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1363
Mailing Address - Country:US
Mailing Address - Phone:703-560-8592
Mailing Address - Fax:703-978-6093
Practice Address - Street 1:5206A ROLLING RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1605
Practice Address - Country:US
Practice Address - Phone:703-560-8592
Practice Address - Fax:703-978-6093
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040034481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS85643Medicare UPIN
VA490391Medicare ID - Type Unspecified