Healthcare Provider Details

I. General information

NPI: 1932893450
Provider Name (Legal Business Name): DIPANA JAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 15TH ST N STE 1003
ARLINGTON VA
22201-2610
US

IV. Provider business mailing address

2000 15TH ST N STE 1003
ARLINGTON VA
22201-2610
US

V. Phone/Fax

Practice location:
  • Phone: 703-520-1072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: