Provider Demographics
NPI:1306980677
Name:FLEITAS, RICHARD P (PSYD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:FLEITAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 PARKLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3616
Mailing Address - Country:US
Mailing Address - Phone:703-200-4193
Mailing Address - Fax:
Practice Address - Street 1:1655 FORT MYER DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-3113
Practice Address - Country:US
Practice Address - Phone:703-200-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003764103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical