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Individual

ELLIETTA MADRIGAL LAZARO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
2001 MILL RD, ALEXANDRIA, VA 22314-5355
(703) 746-3599
(703) 684-2072
Mailing address
206 LEIGHTON AVE, SILVER SPRING, MD 20901-4846
(301) 787-9105

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904010569
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1447279658
VA
Enumeration date
07/16/2018
Last updated
07/31/2024
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