Healthcare Provider Details

I. General information

NPI: 1780058081
Provider Name (Legal Business Name): CLAUDIA CARRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S WASHINGTON ST
ALEXANDRIA VA
22314-4100
US

IV. Provider business mailing address

6616 STONECREST LN
FAIRFAX STATION VA
22039-1200
US

V. Phone/Fax

Practice location:
  • Phone: 703-214-5648
  • Fax:
Mailing address:
  • Phone: 580-583-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005995
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: