Provider Demographics
NPI:1487707535
Name:BARRETT, SANDRA LEE (LCSW-C)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8427 SILVERDALE CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-3065
Mailing Address - Country:US
Mailing Address - Phone:301-316-4176
Mailing Address - Fax:703-646-4368
Practice Address - Street 1:4400 STAMP RD
Practice Address - Street 2:306
Practice Address - City:MARLOW HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20748-6716
Practice Address - Country:US
Practice Address - Phone:301-316-4176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD064661041C0700X
VA09040026581041C0700X
DCLI500776951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD165000900Medicaid