Healthcare Provider Details

I. General information

NPI: 1902318496
Provider Name (Legal Business Name): LISA PAIGE BRESLIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA PAIGE BATEMAN PHD

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 01/24/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 FAIRFAX DR STE 205
ARLINGTON VA
22203-1622
US

IV. Provider business mailing address

4401 FAIRFAX DR STE 205
ARLINGTON VA
22203-1622
US

V. Phone/Fax

Practice location:
  • Phone: 571-328-7408
  • Fax:
Mailing address:
  • Phone: 571-328-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0810005469
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: