Healthcare Provider Details

I. General information

NPI: 1346454733
Provider Name (Legal Business Name): SERGIO IVAN CUETO LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6170 MILES LN
WARRENTON VA
20187-8849
US

IV. Provider business mailing address

33 N CALHOUN ST
WARRENTON VA
20186-3355
US

V. Phone/Fax

Practice location:
  • Phone: 703-655-0762
  • Fax:
Mailing address:
  • Phone: 540-347-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001114
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: