Provider Demographics
NPI:1114931714
Name:LENNON, BARBARA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:LENNON
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 1:12011 GOVERNMENT CENTER PKWY STE 836
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22035-1100
Mailing Address - Country:US
Mailing Address - Phone:703-648-0887
Mailing Address - Fax:703-758-6641
Practice Address - Street 1:3221 W OX RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-1716
Practice Address - Country:US
Practice Address - Phone:703-648-0887
Practice Address - Fax:703-758-6641
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040046391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
010908M47Medicare ID - Type Unspecified