Provider Demographics
NPI:1770475758
Name:MYERS, ISAIAH ROMERO
Entity type:Individual
Prefix:
First Name:ISAIAH
Middle Name:ROMERO
Last Name:MYERS
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 1:6202 BLUE SAGE LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4106
Mailing Address - Country:US
Mailing Address - Phone:240-535-6237
Mailing Address - Fax:
Practice Address - Street 1:10640 PAGE AVE STE 330
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4012
Practice Address - Country:US
Practice Address - Phone:703-744-0609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0730000795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist