MEDICARE: DR. LINDSAY WALKER BLASS PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1073701199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDSAY WALKER BLASS PSY.D.

Provider Business Mailing Address
First Line	:	1707 BELLE VIEW BLVD
Second Line	:	SUITE C-1
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6727
Country	:	US
Telephone Number	:	703-596-5570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 BELLE VIEW BLVD
Second Line	:	SUITE C-1
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6727
Country	:	US
Telephone Number	:	703-596-5570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	12/21/2010

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