Active NPI
Tania Ponomarenko, LCSW
- Clinical Social Worker
- MC Lean, VA
National Provider Identifier
1306895032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904002059
- Practice address
- 6842 Elm St Ste 104
MC Lean, VA 22101-3844 - Phone
- (703) 752-4178
- NPI assigned
- May 9, 2006
- Sex
- Female
- 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 | 0904002059 | VA | Primary |
Addresses
Primary practice location
6842 Elm St Ste 104
MC Lean, VA 22101-3844
Mailing address
6842 Elm St Ste 104
MC Lean, VA 22101-3844
Phone (703) 752-4178
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008932018 | Medicaid | VA | |
| F087 0001 | Other | DC | BLUECROSS BLUESHIELD |
| 138370 | Other | VA | BLUECROSS BLUESHIELD |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456876800000",
"number": "1306895032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6842 ELM ST STE 104",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221013844",
"telephone_number": "703-752-4178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6842 ELM ST STE 104",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221013844",
"telephone_number": "703-752-4178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONOMARENKO",
"first_name": "TANIA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-09",
"last_updated": "2016-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904002059",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008932018",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "F087 0001",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "138370",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in MC Lean, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.