Provider Demographics
NPI:1902534233
Name:SARTORIO, MAGNO PORTER
Entity Type:Individual
Prefix:
First Name:MAGNO
Middle Name:PORTER
Last Name:SARTORIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WIND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-4794
Mailing Address - Country:US
Mailing Address - Phone:540-538-3584
Mailing Address - Fax:
Practice Address - Street 1:1001 WIND RIDGE DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-4794
Practice Address - Country:US
Practice Address - Phone:540-538-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002587103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst