Provider Demographics
NPI:1073655098
Name:REDER, NANCY ELLEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ELLEN
Last Name:REDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:REDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:411 1/2 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2311
Mailing Address - Country:US
Mailing Address - Phone:703-683-2602
Mailing Address - Fax:703-683-2602
Practice Address - Street 1:411 1/2 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2311
Practice Address - Country:US
Practice Address - Phone:703-683-2602
Practice Address - Fax:703-683-2602
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040032701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical