Provider Demographics
NPI:1083491666
Name:MENICK, ALIZA
Entity Type:Individual
Prefix:
First Name:ALIZA
Middle Name:
Last Name:MENICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 GREENSBORO DR STE 350
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3862
Mailing Address - Country:US
Mailing Address - Phone:703-828-7516
Mailing Address - Fax:
Practice Address - Street 1:8180 GREENSBORO DR
Practice Address - Street 2:STE 350
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102
Practice Address - Country:US
Practice Address - Phone:703-828-7516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool