Provider Demographics
NPI:1649458258
Name:BOONE, ANGELA LUZIO (PHD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LUZIO
Last Name:BOONE
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 1:10101 CROOKED CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2955
Mailing Address - Country:US
Mailing Address - Phone:703-582-8858
Mailing Address - Fax:
Practice Address - Street 1:7019 BACKLICK CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3903
Practice Address - Country:US
Practice Address - Phone:703-582-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical