Provider Demographics
NPI:1922578459
Name:SIERVO-LUBIAN, CRISRINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRISRINA
Middle Name:
Last Name:SIERVO-LUBIAN
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 1:46179 WESTLAKE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5882
Mailing Address - Country:US
Mailing Address - Phone:703-430-9070
Mailing Address - Fax:
Practice Address - Street 1:46179 WESTLAKE DR STE 250
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5882
Practice Address - Country:US
Practice Address - Phone:703-430-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA51-0564988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical