Healthcare Provider Details

I. General information

NPI: 1730525205
Provider Name (Legal Business Name): APPLIED NEUROPSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 09/06/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 FAIRFAX BLVD. SUITE 200
FAIRFAX VA
22030-5017
US

IV. Provider business mailing address

PO BOX 640
CENTREVILLE VA
20122-0640
US

V. Phone/Fax

Practice location:
  • Phone: 703-879-5130
  • Fax: 703-635-3681
Mailing address:
  • Phone: 703-879-5130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810003332
License Number StateVA

VIII. Authorized Official

Name: DR. MERCEDES HELENA ALFARO
Title or Position: OWNER
Credential: PH.D.
Phone: 703-879-5130