Active NPI
Fereshteh Khodaei Shahrokhi, LCSW
- Clinical Social Worker
- Burke, VA
National Provider Identifier
1346876182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904003000
- Practice address
- Lyngate CT
Suite 200
Burke, VA 22015 - Phone
- (703) 603-4882
- Fax
- (703) 532-7979
- NPI assigned
- Mar 12, 2020
- 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 | 0904003000 | VA | Primary |
Addresses
Primary practice location
Lyngate CT
Suite 200
Burke, VA 22015
Mailing address
726 Gouldman Lane
Great Falls, VA 22066
Phone (703) 442-3447
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A62484544 | Other | VA | DRIVER'S LICENSE |
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 |
|---|---|---|---|
| 0904003000 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583971200000",
"number": "1346876182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "726 GOULDMAN LANE",
"city": "GREAT FALLS",
"state": "VA",
"postal_code": "22066",
"telephone_number": "703-442-3447",
"fax_number": "703-349-1132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "LYNGATE CT",
"address_2": "SUITE 200",
"city": "BURKE",
"state": "VA",
"postal_code": "22015",
"telephone_number": "703-603-4882",
"fax_number": "703-532-7979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAHROKHI",
"first_name": "FERESHTEH",
"middle_name": "KHODAEI",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-12",
"last_updated": "2020-03-12",
"certification_date": "2020-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904003000",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER'S LICENSE",
"identifier": "A62484544",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.