Provider Demographics
NPI:1952483521
Name:BURGER, LEONORA T (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LEONORA
Middle Name:T
Last Name:BURGER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 BLUE RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5503
Mailing Address - Country:US
Mailing Address - Phone:703-941-4862
Mailing Address - Fax:703-941-4862
Practice Address - Street 1:5112 BLUE RIDGE AVE
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5503
Practice Address - Country:US
Practice Address - Phone:703-941-4862
Practice Address - Fax:703-941-4862
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040002111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VABU 656089Medicare ID - Type Unspecified