Provider Demographics
NPI:1376641613
Name:AHEARN, ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:AHEARN
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 1:907 CORNELL ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4718
Mailing Address - Country:US
Mailing Address - Phone:540-656-6766
Mailing Address - Fax:
Practice Address - Street 1:907 CORNELL ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4718
Practice Address - Country:US
Practice Address - Phone:540-656-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040059431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
373651OtherTRICARE
194131OtherANTHEM