Provider Demographics
NPI:1073539128
Name:VOGEL, CLARE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CLARE
Middle Name:
Last Name:VOGEL
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 1:5274 LYNGATE CT.
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015
Mailing Address - Country:US
Mailing Address - Phone:703-425-7867
Mailing Address - Fax:703-425-7867
Practice Address - Street 1:5274 LYNGATE CT.
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-425-7867
Practice Address - Fax:703-425-7867
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040004121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
653301Medicare ID - Type Unspecified