Provider Demographics
NPI:1568733103
Name:NASANOW, ELLEN SUSAN (PHD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:SUSAN
Last Name:NASANOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 CHAIN BRIDGE RD
Mailing Address - Street 2:#207
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3904
Mailing Address - Country:US
Mailing Address - Phone:202-531-2126
Mailing Address - Fax:
Practice Address - Street 1:8618 WESTWOOD CENTER DR
Practice Address - Street 2:340
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2222
Practice Address - Country:US
Practice Address - Phone:202-531-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004071103TC0700X
CAPSY523103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical