Andrew Ross Wynn, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904017152 Issued in VA

Practice address

2680 Opitz Blvd Ste 220
Woodbridge, VA 22192-6821

Phone

(703) 828-4052

NPI assigned

Aug 1, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: andrew.wynn.1@8042.direct.athenahealth.com

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.

• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480

  DC, Single Specialty

  Medicare reassignment NPD
• Privia Medical Group, LLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Rockville, MD
  • NPI 1811715436
  NPD

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

{
    "created_epoch": "1722470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1912736307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4597 CLEARWATER CT",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220251422",
            "telephone_number": "323-445-3857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 OPITZ BLVD STE 220",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221926821",
            "telephone_number": "703-828-4052"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4597 Clearwater Ct",
            "address_purpose": "LOCATION",
            "city": "Dumfries",
            "state": "VA",
            "postal_code": "220251422",
            "country_code": "US",
            "telephone_number": "323-445-3857",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYNN",
        "first_name": "ANDREW",
        "middle_name": "ROSS",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-08-01",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904017152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Sue Wyman, LPC
• Mary Jane Wyman, M.D.
• Olga Vladimirovna Wymore
• Todd E Wynkoop, DDS
• Alan Howard Wynn, M.D.
• Erica Larae Wynn, M.D.
• Lisa Xantus, LPC
• Duo Xu, APRN
• Y Mentorship Services LLC
• Charles Yaafi

• 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 1, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.