Provider Demographics
NPI:1508053547
Name:BRAYTON, JODI EILEEN (MSW LICSW LCSW)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:EILEEN
Last Name:BRAYTON
Suffix:
Gender:F
Credentials:MSW LICSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6829 ELM ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3884
Mailing Address - Country:US
Mailing Address - Phone:703-532-4892
Mailing Address - Fax:703-237-3105
Practice Address - Street 1:6829 ELM ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3884
Practice Address - Country:US
Practice Address - Phone:703-532-4892
Practice Address - Fax:703-237-3105
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040067191041C0700X
DCLC500778971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical