Healthcare Provider Details

I. General information

NPI: 1730540204
Provider Name (Legal Business Name): PEARL K. ZURICH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 CHAIN BRIDGE RD SUITE 202
MC LEAN VA
22101-4501
US

IV. Provider business mailing address

1485 CHAIN BRIDGE RD SUITE 202
MC LEAN VA
22101-4501
US

V. Phone/Fax

Practice location:
  • Phone: 703-400-0654
  • Fax:
Mailing address:
  • Phone: 703-400-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005387
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: