Healthcare Provider Details

I. General information

NPI: 1457418519
Provider Name (Legal Business Name): MAIA SELENA DEUBERT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 CHAIN BRIDGE RD SUITE 203
MC LEAN VA
22101-5724
US

IV. Provider business mailing address

1489 CHAIN BRIDGE RD SUITE 203
MC LEAN VA
22101-5724
US

V. Phone/Fax

Practice location:
  • Phone: 703-447-6788
  • Fax:
Mailing address:
  • Phone: 703-447-6788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003490
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: