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General NPI Number Information
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NPI Number | 1639748510
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Entity Type | Individual
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Provider Name | ALYSSA POBLETE PHD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 3813 RAINIER DR
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City | FAIRFAX
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State | VA
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Zip | 22033-2984
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Country | US
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Telephone | 703-209-6438
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Fax |
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Provider Business Mailing Address
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Address Line | 3813 RAINIER DR
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City | FAIRFAX
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State | VA
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Zip | 22033-2984
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0810006417
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License Number State | VA
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