Provider Demographics
NPI:1174676381
Name:BOVET, ASTRID (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ASTRID
Middle Name:
Last Name:BOVET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ASTRID
Other - Middle Name:BOVET
Other - Last Name:WILFONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5867 BANNING PL
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3666
Mailing Address - Country:US
Mailing Address - Phone:703-644-2634
Mailing Address - Fax:703-246-3499
Practice Address - Street 1:10520 JUDICIAL DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5115
Practice Address - Country:US
Practice Address - Phone:703-246-4447
Practice Address - Fax:703-246-3499
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040040011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical