Provider Demographics
NPI:1851888028
Name:YAVARI, ROXANA
Entity Type:Individual
Prefix:MISS
First Name:ROXANA
Middle Name:
Last Name:YAVARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 MASSACHUSETTS AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-1447
Mailing Address - Country:US
Mailing Address - Phone:202-595-4899
Mailing Address - Fax:
Practice Address - Street 1:9870 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3908
Practice Address - Country:US
Practice Address - Phone:571-317-5742
Practice Address - Fax:240-366-5142
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician