Provider Demographics
NPI:1275663890
Name:KABAT, ELLEN J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:J
Last Name:KABAT
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 1:878 STATION STREET
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4608
Mailing Address - Country:US
Mailing Address - Phone:703-742-0811
Mailing Address - Fax:
Practice Address - Street 1:11250 ROGER BACON DR
Practice Address - Street 2:#7
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5202
Practice Address - Country:US
Practice Address - Phone:703-481-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040010761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical