Provider Demographics
NPI:1417425679
Name:GASSERT, MARGARET BETH
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:BETH
Last Name:GASSERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9675 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3762
Mailing Address - Country:US
Mailing Address - Phone:717-743-4687
Mailing Address - Fax:
Practice Address - Street 1:9675 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3762
Practice Address - Country:US
Practice Address - Phone:717-743-4687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA09040126481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health