Provider Demographics
NPI:1659789428
Name:AXELROD, ROBERT (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:AXELROD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PIDGEON HILL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6146
Mailing Address - Country:US
Mailing Address - Phone:703-433-5771
Mailing Address - Fax:703-433-5773
Practice Address - Street 1:6 PIDGEON HILL DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165
Practice Address - Country:US
Practice Address - Phone:703-433-5771
Practice Address - Fax:703-433-5773
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040015361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical