Provider Demographics
NPI:1124265657
Name:RUMERMAN, STACEY M (PSYD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:M
Last Name:RUMERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:M
Other - Last Name:CHUFFO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:11130 FAIRFAX BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5035
Mailing Address - Country:US
Mailing Address - Phone:703-691-1326
Mailing Address - Fax:703-691-3553
Practice Address - Street 1:11130 FAIRFAX BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5035
Practice Address - Country:US
Practice Address - Phone:703-691-1326
Practice Address - Fax:703-691-3553
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22338103TC0700X
VA0810004329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical