Provider Demographics
NPI:1942682075
Name:PATEL, DEEPA (LCSW, CSOTP)
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:LCSW, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 523421
Mailing Address - Street 2:ATTN CARMEN WYMAN
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-5421
Mailing Address - Country:US
Mailing Address - Phone:703-339-6471
Mailing Address - Fax:703-339-5651
Practice Address - Street 1:5415 BACKLICK RD # C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3915
Practice Address - Country:US
Practice Address - Phone:703-750-1714
Practice Address - Fax:703-339-5651
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040078591041C0700X
VA0812000610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health