Provider Demographics
NPI:1861410821
Name:MARVIN, BRIAN HENRY (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:HENRY
Last Name:MARVIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3103
Mailing Address - Country:US
Mailing Address - Phone:703-960-5798
Mailing Address - Fax:703-263-1724
Practice Address - Street 1:14150 PARKEAST CIR STE 200
Practice Address - Street 2:SUITE 200
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-4212
Practice Address - Country:US
Practice Address - Phone:703-968-4000
Practice Address - Fax:703-263-1724
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040032311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945107Medicaid
VA038347Medicare PIN