Provider Demographics
NPI:1972117703
Name:GRIGERA, RAQUEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:GRIGERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 L ST NE APT 509
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3575
Mailing Address - Country:US
Mailing Address - Phone:440-220-0769
Mailing Address - Fax:
Practice Address - Street 1:600 PENNSYLVANIA AVE SE STE 340
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-6300
Practice Address - Country:US
Practice Address - Phone:571-328-7408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0805002049103TC0700X
DCPSYA00269103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical