Provider Demographics
NPI:1497865109
Name:NASERI, VIRGINIA MARIE (MSSW LCSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARIE
Last Name:NASERI
Suffix:
Gender:F
Credentials:MSSW LCSW
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:MARIE
Other - Last Name:SALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:616 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743
Practice Address - Country:US
Practice Address - Phone:423-639-3213
Practice Address - Fax:423-639-4692
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW3669104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3923012Medicaid
TN3920247Medicaid
3085291OtherMAGELLAN NAVIGATOR
334969OtherVALUE OPTIONS GROUP
3085291OtherMAGELLAN PINNACLE
3085291OtherMAGELLAN SUMMIT
TN3923012Medicare ID - Type Unspecified
TN3920247Medicare ID - Type Unspecified