Stephanie Logan, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904012509 Issued in VA

Practice address

1360 Beverly Rd Ste 200
MC Lean, VA 22101-3647

Phone

(703) 831-8300

NPI assigned

Jul 8, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: granatogroup.stephanielogan@144557.advancedmd-direct.com

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

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1275104499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 BEVERLY RD STE 200",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221013647",
            "telephone_number": "703-831-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 BEVERLY RD STE 200",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221013647",
            "telephone_number": "703-831-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "STEPHANIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-08",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904012509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "AdvancedMD",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1360 Beverly Rd Ste 200",
            "city": "Mc Lean",
            "state": "VA",
            "country_code": "US",
            "postal_code": "221013647",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lisa Locke
• Stephanie Tyler Locuson, RBT
• Tiffany Loe, PA
• Brielle Taylor Loefflad
• Jessica Loeser
• Theresa C Logan, RDN
• Taylor London
• Hannah Long Viebrock
• Manasi Pandit Long, M.D.
• Megan Long

• Clinical Social Worker in MC Lean, VA
• Providers in MC Lean, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; 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.