Provider Demographics
NPI:1013015999
Name:FAMA, LINDA DOMENICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:DOMENICA
Last Name:FAMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 PARK AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3303
Mailing Address - Country:US
Mailing Address - Phone:703-891-9505
Mailing Address - Fax:
Practice Address - Street 1:313 PARK AVE STE 203
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3303
Practice Address - Country:US
Practice Address - Phone:703-891-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA352673OtherANTHEM BCBS
VA007308P81Medicare ID - Type Unspecified