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General NPI Number Information
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NPI Number | 1760575765
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Entity Type | Individual
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Provider Name | JAMES R PERLSTROM PHD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 2235 CEDAR LN STE 202
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City | VIENNA
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State | VA
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Zip | 22182-5247
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Country | US
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Telephone | 703-752-7881
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Fax | 703-752-7880
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Provider Business Mailing Address
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Address Line | 2235 CEDAR LN SUITE 202
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City | VIENNA
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State | VA
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Zip | 22182-5247
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Country | US
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Telephone | 703-752-7881
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Fax | 703-752-7880
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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 | 0810002163
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 03368
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 173F00000X
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Taxonomy Name | Sleep Specialist (PhD)
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License Number | 0810002163
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License Number State | VA
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