Provider Demographics
NPI:1962734194
Name:FRATTO, TIMOTHY (PHD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:FRATTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 HAMAKER CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2238
Mailing Address - Country:US
Mailing Address - Phone:703-876-0966
Mailing Address - Fax:703-876-1628
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE 103
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2238
Practice Address - Country:US
Practice Address - Phone:703-876-0966
Practice Address - Fax:703-876-1628
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810004180103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical