Healthcare Provider Details

I. General information

NPI: 1790888337
Provider Name (Legal Business Name): JAMIE LEIGH ADLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 GREGG CT
FAIRFAX VA
22033-2811
US

IV. Provider business mailing address

3903L FAIR RIDGE DR PMB 343
FAIRFAX VA
22033-2940
US

V. Phone/Fax

Practice location:
  • Phone: 608-347-4646
  • Fax: 888-682-8114
Mailing address:
  • Phone: 608-347-4646
  • Fax: 888-682-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1785-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: