Provider Demographics
NPI:1740483759
Name:PETERSILIA, ELIZABETH ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:PETERSILIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4509 PARK RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1432
Mailing Address - Country:US
Mailing Address - Phone:706-642-3097
Mailing Address - Fax:703-642-3097
Practice Address - Street 1:8350 RICHMOND HWY
Practice Address - Street 2:515
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-2300
Practice Address - Country:US
Practice Address - Phone:703-704-6495
Practice Address - Fax:703-704-6795
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA09040010021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical