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General NPI Number Information
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NPI Number | 1770239204
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Entity Type | Organization
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Legal Business Name | MY PSYCHIATRIST FALLS CHURCH, PLC
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 6565 ARLINGTON BLVD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3013
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Country | US
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Telephone | 703-596-4796
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Fax |
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Provider Business Mailing Address
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Address Line | 12359 SUNRISE VALLEY DR STE 320
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City | RESTON
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State | VA
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Zip | 20191-3463
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Country | US
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Telephone | 35-964-7967
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MADAN UPRETY
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Credential | MD
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Telephone | 35-964-7967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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