Mary Lou Fahey, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904004560 Issued in VA

Practice address

7969 Ashton Ave
Manassas, VA 20109-2885

Phone

(703) 792-7800

Fax

(703) 792-5699

NPI assigned

Mar 21, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prince William County

  • Ambulance
  • Prince William, VA
  • NPI 1235437385
  NPD (past)
• Prince William County Community Services Board

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Manassas, VA
  • NPI 1053402800
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200528000000",
    "number": "1063537595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7969 ASHTON AVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201092885",
            "telephone_number": "703-792-7800",
            "fax_number": "703-792-5699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7969 ASHTON AVE",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201092885",
            "telephone_number": "703-792-7800",
            "fax_number": "703-792-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHEY",
        "first_name": "MARY",
        "middle_name": "LOU",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2008-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904004560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "292737",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4945247",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "245421",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evergreen Homecare LLC
• Evergreen Neurology and Sleep Center
• Deborah Sue Everist
• Chizimako Margaret Eze, NP
• Carlos Fagbenro, NP
• Fairfax Family Prac Cen
• Fairfax Pathology Associates, LTD.
• Fairland by Medical Transportation LLC
• Abdul Ahad Faisal, MD
• Faith James PHD LPC

• All providers in Manassas, VA
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.