Healthcare Provider Details

I. General information

NPI: 1356866537
Provider Name (Legal Business Name): MEGAN URBASSIK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN GAMMELMO

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 03/23/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N HATCHER AVE # 7
PURCELLVILLE VA
20132-3106
US

IV. Provider business mailing address

140 N HATCHER AVE # 7
PURCELLVILLE VA
20132-3106
US

V. Phone/Fax

Practice location:
  • Phone: 571-210-7818
  • Fax:
Mailing address:
  • Phone: 571-210-7818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005693
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: