Provider Demographics
NPI:1396399267
Name:GIOTTA, MIRIAM WENDY (MA)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:WENDY
Last Name:GIOTTA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:WENDY
Other - Last Name:SCHONFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8700 CENTREVILLE RD # 400
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8430
Mailing Address - Country:US
Mailing Address - Phone:571-377-6779
Mailing Address - Fax:
Practice Address - Street 1:8700 CENTREVILLE RD # 400
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8430
Practice Address - Country:US
Practice Address - Phone:571-377-6779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813000583103TS0200X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool