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General NPI Number Information
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NPI Number | 1831710755
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Entity Type | Organization
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Legal Business Name | RESTON PRECISION NEUROPSYCHOLOGY LLC
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 06/07/2020
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Provider Practice Location Address
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Address Line | 441-D CARLISLE DR., SUITE 103
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City | HERNDON
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State | VA
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Zip | 20170-4802
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Country | US
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Telephone | 703-715-7130
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Fax | 833-520-4863
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Provider Business Mailing Address
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Address Line | 11446 HOLLOW TIMBER CT
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City | RESTON
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State | VA
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Zip | 20194-1980
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL NEUROPSYCHOLOGIST
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Name | DR. NATALIA LUGINA MAURANNE
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Credential | MS, MA, PSYD
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Telephone | 571-529-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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