Provider Demographics
NPI:1346340403
Name:MAISE, RITA THERESA I (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:THERESA
Last Name:MAISE
Suffix:I
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RITA
Other - Middle Name:THERESA
Other - Last Name:MAISWINKLE
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:10125 WOOD GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2714
Mailing Address - Country:US
Mailing Address - Phone:703-503-7849
Mailing Address - Fax:
Practice Address - Street 1:13649 OFFICE PL
Practice Address - Street 2:#102
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4215
Practice Address - Country:US
Practice Address - Phone:703-670-5738
Practice Address - Fax:703-670-8213
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040012611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical