Provider Demographics
NPI:1467668350
Name:QUIG, MARY ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY ELIZABETH
Middle Name:
Last Name:QUIG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3020 HAMAKER CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2238
Mailing Address - Country:US
Mailing Address - Phone:703-876-0966
Mailing Address - Fax:703-876-1628
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE 103
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2238
Practice Address - Country:US
Practice Address - Phone:703-876-0966
Practice Address - Fax:703-876-1628
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810002665103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA490454Medicare ID - Type UnspecifiedPSYCHOLOGIST