Provider Demographics
NPI:1619720729
Name:CAVALHEIRO DA LUZ, ANDERSON
Entity Type:Individual
Prefix:
First Name:ANDERSON
Middle Name:
Last Name:CAVALHEIRO DA LUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANDERSON
Other - Middle Name:
Other - Last Name:LUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3301 SHIRLEY LN
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16900 SCIENCE DR STE 208-210
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4401
Practice Address - Country:US
Practice Address - Phone:703-522-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker