Provider Demographics
NPI:1568618510
Name:MOROTE, GLORIA (PHD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:MOROTE
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 1:424 SOUTH WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314
Mailing Address - Country:US
Mailing Address - Phone:703-683-2695
Mailing Address - Fax:703-683-5454
Practice Address - Street 1:424 SOUTH WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314
Practice Address - Country:US
Practice Address - Phone:703-683-2695
Practice Address - Fax:703-683-5454
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA03930103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC526-139-DCMedicare UPIN