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General NPI Number Information
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NPI Number | 1639683758
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Entity Type | Organization
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Legal Business Name | INTEGRATED PSYCHOLOGY ASSOCIATES OF MCLEAN, LLC
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 6845 ELM ST STE 507
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City | MC LEAN
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State | VA
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Zip | 22101-3859
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Country | US
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Telephone | 703-459-0417
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Fax | 703-454-0601
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Provider Business Mailing Address
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Address Line | 6845 ELM ST STE 507
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City | MC LEAN
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State | VA
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Zip | 22101-3859
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Country | US
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Telephone | 703-459-0417
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Fax | 703-454-0601
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Authorized Official
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Title or Position | DIRECTOR OF PSYCHOLOGICAL SERVICES
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Name | DR. DEBRA N BROSIUS
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Credential | PSY.D
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Telephone | 703-459-0417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | VA0810003478
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License Number State | VA
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