Healthcare Provider Details

I. General information

NPI: 1477337772
Provider Name (Legal Business Name): PATRICIA CISNERO MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9553 BALLAGAN CT
BRISTOW VA
20136-2700
US

IV. Provider business mailing address

9553 BALLAGAN CT
BRISTOW VA
20136-2700
US

V. Phone/Fax

Practice location:
  • Phone: 703-470-7081
  • Fax:
Mailing address:
  • Phone: 703-470-7081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701012792
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0701012792
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701012792
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: