Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810003444 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810003444 | VA |
NPI | 1013015999 |
---|---|
Provider Name | Dr. Linda Domenica Fama |
First Address | Falls Church, VA 22046-3303 |
Second Address | Falls Church, VA 22046-3303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 18/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
352673 | ANTHEM BCBS (01) | VA |