Healthcare Provider Details

I. General information

NPI: 1235687922
Provider Name (Legal Business Name): MR. AARON WEISBROD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR DEPARTMENT OF MENTAL HEALTH
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR DEPARTMENT OF MENTAL HEALTH
PORTSMOUTH VA
23708-2111
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-7641
  • Fax:
Mailing address:
  • Phone: 757-953-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005792
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: