=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346358074
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIKA FRANTZ MADISON PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4080 CHAIN BRIDGE RD
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-246-3484
-----------------------------------------------------
Fax | 703-273-9074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3535 ARMFIELD FARM DR
-----------------------------------------------------
City | CHANTILLY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20151-3365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-689-0160
-----------------------------------------------------
Fax | 703-273-9074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 0810003484
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------