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General NPI Number Information
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NPI Number | 1689925489
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Entity Type | Organization
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Legal Business Name | SUSAN COOK MAYTORENA, PH.D., PLC
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 629 S WASHINGTON ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4109
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Country | US
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Telephone | 703-519-6770
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Fax | 703-229-0801
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Provider Business Mailing Address
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Address Line | 629 S WASHINGTON ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4109
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Country | US
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Telephone | 703-519-6770
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Fax | 703-229-0801
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN COOK MAYTORENA
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Credential | PH.D.
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Telephone | 703-519-6770
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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 | 0810000296
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License Number State | VA
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