Healthcare Provider Details

I. General information

NPI: 1073588364
Provider Name (Legal Business Name): ANGELA PEREIRA PH.D., MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 FARRELL RD
FORT BELVOIR VA
22060-5901
US

IV. Provider business mailing address

18 LAPIDUM RD
HAVRE DE GRACE MD
21078-1504
US

V. Phone/Fax

Practice location:
  • Phone: 703-805-0110
  • Fax: 703-805-0967
Mailing address:
  • Phone: 410-939-5042
  • Fax: 410-939-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10100
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: