=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568563161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVALYN G BISHOP PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 03/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 198 SPOTNAP RD STE A3
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22911-8614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-882-2631
-----------------------------------------------------
Fax | 434-882-2631
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 OAK FOREST CIRCLE
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-882-2631
-----------------------------------------------------
Fax | 434-244-0716
-----------------------------------------------------
=====================================================
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 | 08100001917
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------