Edith Lynne Brokaw, LCSW, CSAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904005800 Issued in VA

Practice address

44081 Pipeline PLZ
#105
Ashburn, VA 20147-5891

Phone

(703) 403-6944

NPI assigned

Aug 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 18, 2017 through May 18, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344384000000",
    "number": "1639284326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44104 NATALIE TER",
            "address_2": "SUITE 102",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201477901",
            "telephone_number": "703-403-6944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44081 PIPELINE PLZ",
            "address_2": "#105",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475891",
            "telephone_number": "703-403-6944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROKAW",
        "first_name": "EDITH",
        "middle_name": "LYNNE",
        "name_prefix": "Ms.",
        "credential": "LCSW, CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2012-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0710102052",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904005800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Nicole Brewer, PT, DPT, ATC
• Melanie Brezovsky, LPC
• Bridgestone Mental Wellness & Therapy
• Juliet Brisbane
• Broadway Home Healthcare Inc
• Arthur Clarence Bronsord, P.T.
• Matthew Brooks, REGISTERED ART THERA
• Aloysius M Broussard, DC
• Jared Roger Brown, DPT
• Michael Joseph Brown, M.D.

• Clinical Social Worker in Ashburn, VA
• Providers in Ashburn, 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 8, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.