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General NPI Number Information
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NPI Number | 1497708374
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Entity Type | Organization
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Legal Business Name | SPECIALIZED PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 5821 STAPLES MILL RD
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City | RICHMOND
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State | VA
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Zip | 23228-5427
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Country | US
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Telephone | 804-264-0966
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Fax | 804-264-1029
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Provider Business Mailing Address
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Address Line | 5821 STAPLES MILL RD
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City | RICHMOND
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State | VA
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Zip | 23228-5427
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Country | US
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Telephone | 804-264-0966
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Fax | 804-264-1029
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURA EGERTON WERT
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Credential | PH.D.
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Telephone | 804-264-0966
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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 | 0810001671
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License Number State | VA
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