=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295905537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOAN BOES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2008
-----------------------------------------------------
Last Update Date | 03/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 EISENHOWER AVE SUITE #402
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22314-4698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-519-7021
-----------------------------------------------------
Fax | 703-299-0716
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1250 S WASHINGTON ST SUITE #509
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22314-4411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-519-7021
-----------------------------------------------------
Fax | 703-299-0716
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. JOAN BOES
-----------------------------------------------------
Credential | PH.D., R.N.
-----------------------------------------------------
Telephone | 703-299-0713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 0810002462
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------