MEDICARE: GLORIA QUEVEDO MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701002903	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7293273	OTHER	VA	AETNA BEHAVIORAL
2	509867669	OTHER	VA	UBH
3	89130013	OTHER	VA	CAREFIRST BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	385442	OTHER	VA	ANTHEM
6	293620	OTHER	VA	MAMSI
7	264926000	OTHER	VA	MAGELLAN
8	541598045	OTHER	VA	NCPPO

General Provider Information

NPI Number	:	1336105279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA QUEVEDO MA, LPC

Provider Business Mailing Address
First Line	:	3801 FAIRFAX DR
Second Line	:	53
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1762
Country	:	US
Telephone Number	:	202-641-5329
Fax Number	:	202-526-0110

Provider Business Practice Location Address
First Line	:	3801 FAIRFAX DR
Second Line	:	53
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1762
Country	:	US
Telephone Number	:	202-641-5329
Fax Number	:	202-526-0110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/29/2011

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Directions to “ GLORIA QUEVEDO MA, LPC” Practice Location

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