Provider Demographics
NPI:1063509826
Name:PARMENTIER, AMY GOODMAN (LCSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:GOODMAN
Last Name:PARMENTIER
Suffix:
Gender:F
Credentials:LCSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21351 GENTRY DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166
Mailing Address - Country:US
Mailing Address - Phone:703-994-8611
Mailing Address - Fax:703-421-9946
Practice Address - Street 1:21351 GENTRY DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166
Practice Address - Country:US
Practice Address - Phone:703-994-8611
Practice Address - Fax:703-421-9946
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040062851041C0700X
MD096881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical