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General NPI Number Information
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NPI Number | 1336871284
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Entity Type | Individual
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Provider Name | TARA AGNESHWAR PSY.D
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Gender | Female
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1221 KING ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2926
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Country | US
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Telephone | 571-478-9499
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Fax |
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Provider Business Mailing Address
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Address Line | 1255 25TH ST NW APT 730
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City | WASHINGTON
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State | DC
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Zip | 20037-4112
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Country | US
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Telephone | 607-221-1468
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810008867
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License Number State | VA
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