Provider Demographics
NPI:1083751648
Name:GOGLIA, LINDA ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ROSE
Last Name:GOGLIA
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 1:11333 SUNSET HILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5205
Mailing Address - Country:US
Mailing Address - Phone:703-620-9052
Mailing Address - Fax:703-464-0507
Practice Address - Street 1:11333 SUNSET HILLS ROAD
Practice Address - Street 2:LINDA R GOGLIA PHD
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5205
Practice Address - Country:US
Practice Address - Phone:703-620-9052
Practice Address - Fax:703-464-0507
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA555786Medicare ID - Type Unspecified