MEDICARE: DR. HELEN W. REZNICK PH.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	0810001878	VA

General Provider Information

NPI Number	:	1780785824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HELEN W. REZNICK PH.D.

Provider Business Mailing Address
First Line	:	1225 MARTHA CUSTIS DR
Second Line	:	SUITE 2
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-2000
Country	:	US
Telephone Number	:	703-379-9520
Fax Number	:	703-379-9529

Provider Business Practice Location Address
First Line	:	1225 MARTHA CUSTIS DR
Second Line	:	SUITE 2
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-2000
Country	:	US
Telephone Number	:	703-379-9520
Fax Number	:	703-379-9529

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/09/2007

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