Kelly Facciola, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904005064 Issued in VA

Practice address

12866 Harbor Dr
Woodbridge, VA 22192-2921

Phone

(703) 494-4164

Fax

(703) 563-9304

NPI assigned

Aug 25, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Occoquan Counseling LLCGroup PAC ID 0446327647, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Occoquan Counseling, LLC

  • Clinical Social Worker
  • Woodbridge, VA
  • NPI 1780834911
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565136000000",
    "number": "1598873101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12866 HARBOR DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922921",
            "telephone_number": "703-203-7535",
            "fax_number": "703-563-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12866 HARBOR DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922921",
            "telephone_number": "703-494-4164",
            "fax_number": "703-563-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACCIOLA",
        "first_name": "KELLY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2019-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904005064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010023700",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Express Pharmacy
• Exservice Members Paying It Forward
• Ez Access LLC
• Rachel C Ezeani
• Obinna Ezekwe, PHARM.D
• Jennifer Faherty, MOT, OTR/L
• Obaidullah Faiq, OD
• Faith Global Healthcare LLC
• Faith Home Healthcare, LLC
• Tina Janet Falika King, M.D., M.P.H.

• Clinical Social Worker in Woodbridge, VA
• Providers in Woodbridge, 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 Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.