Provider Demographics
NPI:1619327822
Name:ALTIERO, JOANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:
Last Name:ALTIERO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOANN
Other - Middle Name:VICTORIA
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:7765 SUTTON CT
Mailing Address - Street 2:
Mailing Address - City:PORT TOBACCO
Mailing Address - State:MD
Mailing Address - Zip Code:20677-2032
Mailing Address - Country:US
Mailing Address - Phone:301-392-3877
Mailing Address - Fax:
Practice Address - Street 1:7765 SUTTON CT
Practice Address - Street 2:
Practice Address - City:PORT TOBACCO
Practice Address - State:MD
Practice Address - Zip Code:20677-2032
Practice Address - Country:US
Practice Address - Phone:301-392-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03365103TC0700X
VA0810000184103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical