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General NPI Number Information
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NPI Number | 1114299062
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Entity Type | Individual
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Provider Name | RAIA STEFANOVA MARGO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 1701 K ST NW SUITE 1125
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City | WASHINGTON
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State | DC
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Zip | 20006-1503
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Country | US
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Telephone | 805-637-7832
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Fax |
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Provider Business Mailing Address
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Address Line | 3120 DUMBARTON ST NW
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City | WASHINGTON
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State | DC
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Zip | 20007-3308
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Country | US
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Telephone | 805-637-7832
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1000627
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 019300
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License Number State | NY
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