Healthcare Provider Details

I. General information

NPI: 1174509806
Provider Name (Legal Business Name): GIOVANNA MORENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 STEVENSON AVE STE 208
ALEXANDRIA VA
22304-3526
US

IV. Provider business mailing address

6000 STEVENSON AVE STE 208
ALEXANDRIA VA
22304-3526
US

V. Phone/Fax

Practice location:
  • Phone: 301-518-2542
  • Fax:
Mailing address:
  • Phone: 703-379-7215
  • Fax: 202-265-7804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberD41463
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: