Provider Demographics
NPI:1508915224
Name:IANNONE, VIRGINIA (PHD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:IANNONE
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 1:5030 MORNING STAR DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MD
Mailing Address - Zip Code:21036-1116
Mailing Address - Country:US
Mailing Address - Phone:443-864-9300
Mailing Address - Fax:410-298-8225
Practice Address - Street 1:9650 SANTIAGO RD
Practice Address - Street 2:SUITE 3
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3957
Practice Address - Country:US
Practice Address - Phone:443-864-9300
Practice Address - Fax:410-298-8225
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical