Healthcare Provider Details

I. General information

NPI: 1669444360
Provider Name (Legal Business Name): JOY P KANNARKAT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 LYNNHAVEN PKWY SUITE 240
VIRGINIA BEACH VA
23452-7324
US

IV. Provider business mailing address

770 LYNNHAVEN PKWY SUITE 240
VIRGINIA BEACH VA
23452-7324
US

V. Phone/Fax

Practice location:
  • Phone: 757-962-2780
  • Fax: 757-240-5936
Mailing address:
  • Phone: 757-962-2780
  • Fax: 757-240-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810000814
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: