Provider Demographics
NPI:1568772911
Name:FARWELL-ASH, BERYL (LCSW)
Entity Type:Individual
Prefix:
First Name:BERYL
Middle Name:
Last Name:FARWELL-ASH
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 1:8401 DORSEY CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8303
Mailing Address - Country:US
Mailing Address - Phone:703-330-5155
Mailing Address - Fax:703-330-5925
Practice Address - Street 1:8401 DORSEY CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8303
Practice Address - Country:US
Practice Address - Phone:703-330-5155
Practice Address - Fax:703-330-5925
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040033881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical