Healthcare Provider Details

I. General information

NPI: 1649255969
Provider Name (Legal Business Name): AMARJEET SINGH PUREWAL PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 TOMCAT BLVD
VIRGINIA BEACH VA
23460
US

IV. Provider business mailing address

2329 LONDALE CT
VIRGINIA BEACH VA
23456-6334
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-3985
  • Fax:
Mailing address:
  • Phone: 571-480-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1171
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: