Provider Demographics
NPI:1073606497
Name:RAYBUCK, MARYANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:RAYBUCK
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 1:3310 GUNSTON RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2133
Mailing Address - Country:US
Mailing Address - Phone:703-379-5734
Mailing Address - Fax:
Practice Address - Street 1:50 S PICKETT ST
Practice Address - Street 2:SUITE 224
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7207
Practice Address - Country:US
Practice Address - Phone:703-216-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040054461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical