Provider Demographics
NPI:1386880276
Name:BEVERLY A. BROSKY, PSY.D., PLLC
Entity type:Organization
Organization Name:BEVERLY A. BROSKY, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-550-1140
Mailing Address - Street 1:5021 SEMINARY RD
Mailing Address - Street 2:SUITE 229
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1945
Mailing Address - Country:US
Mailing Address - Phone:703-550-1140
Mailing Address - Fax:703-575-8090
Practice Address - Street 1:5021 SEMINARY RD
Practice Address - Street 2:SUITE 229
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1945
Practice Address - Country:US
Practice Address - Phone:703-550-1140
Practice Address - Fax:703-575-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417069493OtherNPI NUMBER