Healthcare Provider Details

I. General information

NPI: 1639683758
Provider Name (Legal Business Name): INTEGRATED PSYCHOLOGY ASSOCIATES OF MCLEAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 ELM ST STE 507
MC LEAN VA
22101-3859
US

IV. Provider business mailing address

6845 ELM ST STE 507
MC LEAN VA
22101-3859
US

V. Phone/Fax

Practice location:
  • Phone: 703-459-0417
  • Fax: 703-454-0601
Mailing address:
  • Phone: 703-459-0417
  • Fax: 703-454-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberVA0810003478
License Number StateVA

VIII. Authorized Official

Name: DR. DEBRA N BROSIUS
Title or Position: DIRECTOR OF PSYCHOLOGICAL SERVICES
Credential: PSY.D
Phone: 703-459-0417