Healthcare Provider Details

I. General information

NPI: 1669141594
Provider Name (Legal Business Name): NATALIE LAUREN WILVER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE LAUREN MATHENY

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 MAIN ST # 1291
FAIRFAX VA
22031-4032
US

IV. Provider business mailing address

9480 MAIN ST # 1291
FAIRFAX VA
22031-4032
US

V. Phone/Fax

Practice location:
  • Phone: 571-543-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11687-PY-PR
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008182
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: