Healthcare Provider Details

I. General information

NPI: 1841212297
Provider Name (Legal Business Name): RICHARD JOSEPH TAIBI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10520 JUDICIAL DR MENTAL HEALTH SERVICES
FAIRFAX VA
22030
US

IV. Provider business mailing address

MENTAL HEALTH SERVICES 10520 JUDICIAL DR
FAIRFAX VA
22030
US

V. Phone/Fax

Practice location:
  • Phone: 703-246-4454
  • Fax: 703-383-9638
Mailing address:
  • Phone: 703-246-4454
  • Fax: 703-383-9638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1002
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: