Provider Demographics
NPI:1396480968
Name:ORGERON, KATHERINE CONSTANTINOVA
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CONSTANTINOVA
Last Name:ORGERON
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 1:15819 LAZY DAY LN
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1822
Mailing Address - Country:US
Mailing Address - Phone:415-640-8893
Mailing Address - Fax:
Practice Address - Street 1:2126 PATRIOT HWY STE 103
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:540-658-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007811103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical