MEDICARE: MARY HANNAH POOLE PSYD

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	103TC0700X	Clinical Psychologist	810008989	VA

General Provider Information

NPI Number	:	1992481675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY HANNAH POOLE PSYD

Provider Business Mailing Address
First Line	:	1600 DUKE STREET
Second Line	:	SUITE 350
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314
Country	:	US
Telephone Number	:	703-618-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 DUKE ST # 350
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-3466
Country	:	US
Telephone Number	:	703-618-0900
Fax Number	:

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

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	10/15/2025

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