Provider Demographics
NPI:1467548818
Name:KINNANE, MARIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:KINNANE
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 1:3801 N. FAIRFAX DRIVE
Mailing Address - Street 2:ARLINGTON
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203
Mailing Address - Country:US
Mailing Address - Phone:703-528-7270
Mailing Address - Fax:202-625-0076
Practice Address - Street 1:3801 FAIRFAX DR
Practice Address - Street 2:ARLINGTON
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1762
Practice Address - Country:US
Practice Address - Phone:703-528-7270
Practice Address - Fax:202-625-0076
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040023951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008912556Medicaid
VAS11171Medicare UPIN
VA008912556Medicaid