Provider Demographics
NPI:1356498315
Name:BORMAN, ELLEN GAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:GAY
Last Name:BORMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:GAY
Other - Last Name:BORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1800 SOLITAIRE LN
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4200
Mailing Address - Country:US
Mailing Address - Phone:703-237-3045
Mailing Address - Fax:703-760-0977
Practice Address - Street 1:1800 SOLITAIRE LN
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4200
Practice Address - Country:US
Practice Address - Phone:703-237-3045
Practice Address - Fax:703-760-0977
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA090400440371041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool