Provider Demographics
NPI:1710175187
Name:SAX-MOORE, NINA ROBIN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:ROBIN
Last Name:SAX-MOORE
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 1:1850 CAMERON GLEN DR
Mailing Address - Street 2:SUITE # 600
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3363
Mailing Address - Country:US
Mailing Address - Phone:703-481-4234
Mailing Address - Fax:703-435-1961
Practice Address - Street 1:1850 CAMERON GLEN DR
Practice Address - Street 2:SUITE # 600
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3363
Practice Address - Country:US
Practice Address - Phone:703-481-4234
Practice Address - Fax:703-435-1961
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040066851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical