Healthcare Provider Details

I. General information

NPI: 1730662735
Provider Name (Legal Business Name): JEREMY STEGLITZ PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34380 WILLIAMS GAP RD
ROUND HILL VA
20141-2101
US

IV. Provider business mailing address

34380 WILLIAMS GAP RD
ROUND HILL VA
20141-2101
US

V. Phone/Fax

Practice location:
  • Phone: 202-630-8625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005964
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1001405
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: