Provider Demographics
NPI:1275916413
Name:AMENDOLA, CLAUDIA PATRICIA
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:PATRICIA
Last Name:AMENDOLA
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 1:1800 DIAGONAL RD STE 600
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2840
Mailing Address - Country:US
Mailing Address - Phone:571-346-7616
Mailing Address - Fax:
Practice Address - Street 1:1904 SHERWOOD HALL LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-2735
Practice Address - Country:US
Practice Address - Phone:305-310-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005608103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program