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General NPI Number Information
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NPI Number | 1255092045
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Entity Type | Organization
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Legal Business Name | OPEN SKY THERAPY PLLC
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 6017 WILLIAMSBURG RD
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City | ALEXANDRIA
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State | VA
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Zip | 22303-2213
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Country | US
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Telephone | 202-436-2536
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Fax |
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Provider Business Mailing Address
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Address Line | 6017 WILLIAMSBURG RD
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City | ALEXANDRIA
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State | VA
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Zip | 22303-2213
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JASON DERAMO
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Credential | LCSW
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Telephone | 202-436-2536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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