Provider Demographics
NPI:1891062618
Name:WERTH, MARIANNE LONGSHORE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:LONGSHORE
Last Name:WERTH
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 1:8000 FORBES PL STE 201
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-2203
Mailing Address - Country:US
Mailing Address - Phone:703-425-9200
Mailing Address - Fax:703-525-9206
Practice Address - Street 1:8000 FORBES PL STE 201
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-2203
Practice Address - Country:US
Practice Address - Phone:703-425-9200
Practice Address - Fax:703-525-9206
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040019651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical