Provider Demographics
NPI:1790848091
Name:NAVARRO, PAOLA (MA CERTIFIED EARLY I)
Entity Type:Individual
Prefix:MS
First Name:PAOLA
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:MA CERTIFIED EARLY I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 DARTMOUTH RD
Mailing Address - Street 2:APT 6
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4950
Mailing Address - Country:US
Mailing Address - Phone:617-308-7588
Mailing Address - Fax:
Practice Address - Street 1:3802 EXECUTIVE AVE
Practice Address - Street 2:D-1
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2112
Practice Address - Country:US
Practice Address - Phone:703-535-7930
Practice Address - Fax:703-535-7950
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MA6544101YM0800X
VA0701004918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist