Individual
MRS. MADELINE PETRIZZI JURICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1800 TOWN CENTER DR, STE 411, RESTON, VA 20190
(703) 437-3236
(703) 435-7422
Mailing address
1800 TOWN CENTER DR, STE 411, RESTON, VA 20190
(703) 437-3236
(703) 435-7422
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
0904002351
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101380
ANTHEM BCBS
VA
01
—
127232
VALUE OPTIONS
—
Enumeration date
10/16/2006
Last updated
07/08/2007
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