Provider Demographics
NPI:1700190253
Name:ARENA, MARYAM KATHRINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:KATHRINE
Last Name:ARENA
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 1:19441 GOLF VISTA PLZ
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8269
Mailing Address - Country:US
Mailing Address - Phone:703-678-1533
Mailing Address - Fax:703-729-8836
Practice Address - Street 1:19441 GOLF VISTA PLZ
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8269
Practice Address - Country:US
Practice Address - Phone:703-678-1533
Practice Address - Fax:703-729-8836
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003821103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical