Provider Demographics
NPI:1063883742
Name:NORTHERN VIRGINIA PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:NORTHERN VIRGINIA PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTICK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:571-217-5726
Mailing Address - Street 1:9707 COMMONWEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2824
Mailing Address - Country:US
Mailing Address - Phone:571-217-5726
Mailing Address - Fax:
Practice Address - Street 1:9707 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2824
Practice Address - Country:US
Practice Address - Phone:571-217-5726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty