Active NPI
Robert G Rother, LCSW
- Clinical Social Worker
- Reston, VA
National Provider Identifier
1215955836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904004526
- Practice address
- 11260 Roger Bacon Dr
# 500
Reston, VA 20190-5227 - Phone
- (571) 437-5455
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904004526 | VA | Primary |
Addresses
Primary practice location
11260 Roger Bacon Dr
# 500
Reston, VA 20190-5227
Mailing address
1465 Hunter View Farms
Vienna, VA 22182-1552
Phone (571) 437-5455
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0007466396 | Other | VA | AETNA |
| 0904004526 | Other | VA | LCSW DEPT OF HEALTH PROFF |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0904004526 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215955836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1465 HUNTER VIEW FARMS",
"city": "VIENNA",
"state": "VA",
"postal_code": "221821552",
"telephone_number": "571-437-5455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11260 ROGER BACON DR",
"address_2": "# 500",
"city": "RESTON",
"state": "VA",
"postal_code": "201905227",
"telephone_number": "571-437-5455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTHER",
"first_name": "ROBERT",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904004526",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0007466396",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW DEPT OF HEALTH PROFF",
"identifier": "0904004526",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Reston, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.