Healthcare Provider Details

I. General information

NPI: 1629996657
Provider Name (Legal Business Name): GRACE CARAVETTA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6035 BURKE CENTRE PKWY STE 280
BURKE VA
22015-3750
US

IV. Provider business mailing address

3927 FAIR RIDGE DR STE 303
FAIRFAX VA
22033-2998
US

V. Phone/Fax

Practice location:
  • Phone: 703-239-3470
  • Fax:
Mailing address:
  • Phone: 845-915-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024197575
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: