Healthcare Provider Details

I. General information

NPI: 1952352916
Provider Name (Legal Business Name): MERCEDES HELENA ALFARO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6262 CLAY PIPE CT
CENTREVILLE VA
20121-5620
US

IV. Provider business mailing address

PO BOX 640
CENTREVILLE VA
20122-0640
US

V. Phone/Fax

Practice location:
  • Phone: 703-879-5130
  • Fax: 703-635-3681
Mailing address:
  • Phone: 703-879-5130
  • Fax: 703-635-3681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810003332
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: