Provider Demographics
NPI:1194804914
Name:BARRY B EKDOM PHD, PC
Entity type:Organization
Organization Name:BARRY B EKDOM PHD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHEMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-573-3573
Mailing Address - Street 1:3040 WILLIAMS DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:703-573-3575
Mailing Address - Fax:703-573-3574
Practice Address - Street 1:3040 WILLIAMS DR
Practice Address - Street 2:SUITE 402
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4618
Practice Address - Country:US
Practice Address - Phone:703-573-3575
Practice Address - Fax:703-573-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA081001775103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty