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General NPI Number Information
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NPI Number | 1073921185
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Entity Type | Organization
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Legal Business Name | MCCLEARY PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 08/01/2014
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 13043 QUALLS LN
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City | WOODBRIDGE
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State | VA
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Zip | 22193-4559
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Country | US
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Telephone | 786-663-7128
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Fax |
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Provider Business Mailing Address
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Address Line | 13043 QUALLS LN
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City | WOODBRIDGE
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State | VA
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Zip | 22193-4559
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Country | US
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Telephone | 786-663-7128
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. CAROL SANTANA MCCLEARY
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Credential | PSYD
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Telephone | 786-663-7128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810004890
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License Number State | VA
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