Provider Demographics
NPI:1356749766
Name:GUERRERO, GRACE LANGEBECK (PSYD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:LANGEBECK
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:YVETTE
Other - Last Name:LANGEBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2300 PIMMIT DR. #115
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2837
Mailing Address - Country:US
Mailing Address - Phone:703-447-8930
Mailing Address - Fax:
Practice Address - Street 1:2300 PIMMIT DR. #115
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2837
Practice Address - Country:US
Practice Address - Phone:703-447-8930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04767103TC0700X
VA0810004437103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical