Healthcare Provider Details

I. General information

NPI: 1942045695
Provider Name (Legal Business Name): APPLIED NEUROPSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14120A ROUTE 29 #640
CENTREVILLE VA
20120
US

IV. Provider business mailing address

PO BOX 640
CENTREVILLE VA
20122-0640
US

V. Phone/Fax

Practice location:
  • Phone: 703-879-5130
  • Fax:
Mailing address:
  • Phone: 703-879-5130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MERCEDES HELENA ALFARO
Title or Position: PRESIDENT/DIRECTOR
Credential:
Phone: 703-879-5130