Provider Demographics
NPI:1376269118
Name:ALIREZA, BADREYYAH
Entity Type:Individual
Prefix:
First Name:BADREYYAH
Middle Name:
Last Name:ALIREZA
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 1:12168 TRYTON WAY
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3281
Mailing Address - Country:US
Mailing Address - Phone:703-851-3623
Mailing Address - Fax:
Practice Address - Street 1:12168 TRYTON WAY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3281
Practice Address - Country:US
Practice Address - Phone:703-851-3623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040027491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical