Provider Demographics
NPI:1548928773
Name:LUGO, QUERIDA TAINA
Entity type:Individual
Prefix:
First Name:QUERIDA
Middle Name:TAINA
Last Name:LUGO
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 1:1602 BELLE VIEW BLVD # 5044
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-6531
Mailing Address - Country:US
Mailing Address - Phone:703-470-9397
Mailing Address - Fax:
Practice Address - Street 1:2920 DISTRICT AVE APT 512
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4471
Practice Address - Country:US
Practice Address - Phone:703-470-9397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker