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General NPI Number Information
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NPI Number | 1780824243
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Entity Type | Organization
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Legal Business Name | STANTON E. SAMENOW, PH.D., P.C.
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 4921 SEMINARY ROAD SUITE 104
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City | ALEXANDRIA
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State | VA
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Zip | 22311
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Country | US
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Telephone | 703-931-0004
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Fax | 703-379-7288
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Provider Business Mailing Address
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Address Line | 4921 SEMINARY ROAD
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City | ALEXANDRIA
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State | VA
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Zip | 22311
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Country | US
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Telephone | 703-931-0004
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Fax | 703-379-7288
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Authorized Official
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Title or Position | PRESIDENT
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Name | STANTON E. SAMENOW
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Credential | PH.D.
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Telephone | 703-931-0004
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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 | VA. LIC. #621
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License Number State | VA
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