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General NPI Number Information
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NPI Number | 1336672872
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Entity Type | Organization
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Legal Business Name | BONDANZA PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 2000 15TH ST N SUITE 200
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City | ARLINGTON
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State | VA
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Zip | 22201-2683
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Country | US
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Telephone | 347-301-4399
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Fax |
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Provider Business Mailing Address
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Address Line | 605 N IRVING ST APT 31
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City | ARLINGTON
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State | VA
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Zip | 22201-2046
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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 | CLINICAL PSYCHOLOGIST
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Name | DR. ALLISON BONDANZA
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Credential | PHD
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Telephone | 347-301-4399
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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 | 0810005348
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License Number State | VA
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