Healthcare Provider Details

I. General information

NPI: 1851889679
Provider Name (Legal Business Name): MARIA PATEREAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 KING CENTRE DR
ALEXANDRIA VA
22315-5757
US

IV. Provider business mailing address

8420 STABLE DR
ALEXANDRIA VA
22308-2240
US

V. Phone/Fax

Practice location:
  • Phone: 312-965-2997
  • Fax:
Mailing address:
  • Phone: 210-818-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: