Provider Demographics
NPI:1649498809
Name:GUTMAN, VIRGINIA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ANN
Last Name:GUTMAN
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 1:2709 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2811
Mailing Address - Country:US
Mailing Address - Phone:703-568-3744
Mailing Address - Fax:
Practice Address - Street 1:1225 MARTHA CUSTIS DR
Practice Address - Street 2:C-2
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2000
Practice Address - Country:US
Practice Address - Phone:703-568-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001537103T00000X
DCPSY1094103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist