Healthcare Provider Details

I. General information

NPI: 1346042009
Provider Name (Legal Business Name): KATHERINE ALTAMIRANO LCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CAMERON GLEN DR STE 600
RESTON VA
20190-3343
US

IV. Provider business mailing address

1850 CAMERON GLEN DR STE 600
RESTON VA
20190-3343
US

V. Phone/Fax

Practice location:
  • Phone: 703-559-3000
  • Fax:
Mailing address:
  • Phone: 703-559-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904018118
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: