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General NPI Number Information
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NPI Number | 1396480968
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Entity Type | Individual
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Provider Name | KATHERINE CONSTANTINOVA ORGERON
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Gender | Female
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 2126 PATRIOT HWY STE 103
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City | STAFFORD
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State | VA
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Zip | 22554
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Country | US
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Telephone | 540-658-0888
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Fax |
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Provider Business Mailing Address
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Address Line | 15819 LAZY DAY LN
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City | MONTCLAIR
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State | VA
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Zip | 22025-1822
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Country | US
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Telephone | 415-640-8893
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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 | 0810007811
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License Number State | VA
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