Healthcare Provider Details

I. General information

NPI: 1922017565
Provider Name (Legal Business Name): ANGELICA M ESCALONA PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

500 MADISON ST UNIT 219
ALEXANDRIA VA
22314-1992
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-5422
  • Fax:
Mailing address:
  • Phone: 305-926-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberB10000739
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberB10000739
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: