Provider Demographics
NPI:1184925083
Name:SUNDARESAN, ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:SUNDARESAN
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 1:11445 SUNSET HILLS RD
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5276
Mailing Address - Country:US
Mailing Address - Phone:703-709-1650
Mailing Address - Fax:703-709-1840
Practice Address - Street 1:11445 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5276
Practice Address - Country:US
Practice Address - Phone:703-709-1650
Practice Address - Fax:703-709-1840
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040069591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical