Provider Demographics
NPI:1962045120
Name:HERRITY, PATRICIA RODGERS (LCSW, RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RODGERS
Last Name:HERRITY
Suffix:
Gender:F
Credentials:LCSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14150 PARKEAST CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-4212
Mailing Address - Country:US
Mailing Address - Phone:703-502-7015
Mailing Address - Fax:703-449-6110
Practice Address - Street 1:14150 PARKEAST CIR STE 200
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-4212
Practice Address - Country:US
Practice Address - Phone:703-449-6115
Practice Address - Fax:703-449-6110
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001240312163W00000X
VA0904011312104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No163W00000XNursing Service ProvidersRegistered Nurse