Healthcare Provider Details

I. General information

NPI: 1912508623
Provider Name (Legal Business Name): GLORIA PASAREVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 TOWERS CRESCENT DR FL 13
VIENNA VA
22182-6211
US

IV. Provider business mailing address

850 TOWBIN AVE
LAKEWOOD NJ
08701-5928
US

V. Phone/Fax

Practice location:
  • Phone: 833-599-2560
  • Fax:
Mailing address:
  • Phone: 732-515-3709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133002875
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: