Provider Demographics
NPI:1407462286
Name:LAUTAR, ANDREW (LICSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LAUTAR
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 ARLINGTON TER
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1500
Mailing Address - Country:US
Mailing Address - Phone:410-340-2641
Mailing Address - Fax:
Practice Address - Street 1:500 INDIANA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2131
Practice Address - Country:US
Practice Address - Phone:202-879-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040107381041C0700X
DCLC500801361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical