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General NPI Number Information
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NPI Number | 1730723164
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Entity Type | Individual
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Provider Name | SAMANTHA AVILES MERAW PSY.D
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Gender | Female
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 21001 SYCOLIN RD STE 360
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City | ASHBURN
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State | VA
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Zip | 20147-4073
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Country | US
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Telephone | 783-858-7838
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Fax |
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Provider Business Mailing Address
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Address Line | 21001 SYCOLIN RD # 360
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City | ASHBURN
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State | VA
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Zip | 20147-4073
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Country | US
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Telephone | 703-858-7838
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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 | 0810007263
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License Number State | VA
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