Provider Demographics
NPI:1740209378
Name:SEDAGHATFAR, ELIZABETH NAAR (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NAAR
Last Name:SEDAGHATFAR
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 1:1577 INLET CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4425
Mailing Address - Country:US
Mailing Address - Phone:703-298-2290
Mailing Address - Fax:703-925-6925
Practice Address - Street 1:1577 INLET CT
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4425
Practice Address - Country:US
Practice Address - Phone:703-298-2290
Practice Address - Fax:703-925-6925
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904004936101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904004936OtherCLINICAL LICENSE #
VA491030Medicare ID - Type UnspecifiedMEDICARE PROVIDER #