Provider Demographics
NPI:1629757455
Name:BASAURI FLORES, MARIE ANGELIQUE EUGENIE (VA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ANGELIQUE EUGENIE
Last Name:BASAURI FLORES
Suffix:
Gender:F
Credentials:VA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5176
Mailing Address - Country:US
Mailing Address - Phone:571-474-5961
Mailing Address - Fax:
Practice Address - Street 1:3541 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2793
Practice Address - Country:US
Practice Address - Phone:703-218-6599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002574103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst