Healthcare Provider Details

I. General information

NPI: 1083133631
Provider Name (Legal Business Name): SIMONA EFANOV PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE STE 240
WASHINGTON DC
20003-4370
US

IV. Provider business mailing address

1805 CRYSTAL DR APT 915
ARLINGTON VA
22202-4420
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5440
  • Fax:
Mailing address:
  • Phone: 202-322-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005736
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: