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General NPI Number Information
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NPI Number | 1710193552
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Entity Type | Organization
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Legal Business Name | RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 417 EMMET STREET, SOUTH
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22904-4270
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Country | US
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Telephone | 434-924-7034
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Fax | 434-924-4621
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Provider Business Mailing Address
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Address Line | 417 EMMET STREET, SOUTH P.O. BOX 400270
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22904-4270
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Country | US
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Telephone | 434-924-7034
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Fax | 434-924-4621
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Authorized Official
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Title or Position | CENTER MANAGER
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Name | PATTY H CARPENTER
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Credential |
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Telephone | 434-924-1406
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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 | 103TCO700X
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License Number State | VA
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