Healthcare Provider Details

I. General information

NPI: 1144637240
Provider Name (Legal Business Name): AVITAL YAEL DESKALO LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 S. WASHINGTON ST, SUITE 201, #1025
ALEXANDRIA VA
22314
US

IV. Provider business mailing address

6421 N ELM TREE RD
MILWAUKEE WI
53217-4127
US

V. Phone/Fax

Practice location:
  • Phone: 703-249-9084
  • Fax: 202-650-6362
Mailing address:
  • Phone: 414-324-8283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number713690
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1001213
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: