Healthcare Provider Details

I. General information

NPI: 1700336021
Provider Name (Legal Business Name): ANGELINA NORTEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 PENDLETON ST
ALEXANDRIA VA
22314
US

IV. Provider business mailing address

5500 COLUMBIA PIKE APT 106
ARLINGTON VA
22204-3188
US

V. Phone/Fax

Practice location:
  • Phone: 703-664-0427
  • Fax:
Mailing address:
  • Phone: 845-270-1178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1001203
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5767
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number47474
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810006273
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: