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General NPI Number Information
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NPI Number | 1487916284
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Entity Type | Organization
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Legal Business Name | ALEXANDER BORY PHD PC
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 1119 CAROLINE ST
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3815
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Country | US
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Telephone | 540-371-2251
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Fax | 540-371-2930
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Provider Business Mailing Address
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Address Line | 1119 CAROLINE ST
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3815
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Country | US
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Telephone | 540-371-2251
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Fax | 540-371-2930
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDER BORY
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Credential | PHD
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Telephone | 540-371-2251
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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 | 0810001956
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License Number State | VA
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