Healthcare Provider Details

I. General information

NPI: 1972117703
Provider Name (Legal Business Name): RAQUEL GRIGERA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PENNSYLVANIA AVE SE STE 340
WASHINGTON DC
20003-6300
US

IV. Provider business mailing address

300 L ST NE APT 509
WASHINGTON DC
20002-3575
US

V. Phone/Fax

Practice location:
  • Phone: 571-328-7408
  • Fax:
Mailing address:
  • Phone: 440-220-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0805002049
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSYA00269
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: