MEDICARE: MRS. DANIELLE STETZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	0813000573	VA

General Provider Information

NPI Number	:	1154811180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE STETZ

Provider Business Mailing Address
First Line	:	1004 N VAIL ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-1939
Country	:	US
Telephone Number	:	814-490-2773
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 N STUART ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-5126
Country	:	US
Telephone Number	:	703-228-6275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	05/15/2018

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Directions to “ MRS. DANIELLE STETZ ” Practice Location

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