Provider Demographics
NPI:1811680846
Name:ELCANO, JEFFREY COOKE (LCSW-S)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:COOKE
Last Name:ELCANO
Suffix:
Gender:M
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 HUNTER PL STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3938
Mailing Address - Country:US
Mailing Address - Phone:571-316-1069
Mailing Address - Fax:571-402-7907
Practice Address - Street 1:2510 HUNTER PL STE 101
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3938
Practice Address - Country:US
Practice Address - Phone:571-316-1069
Practice Address - Fax:571-402-7907
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060139041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical