MEDICARE: DR. CHRISTIAN AMALU PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	14038	NE

General Provider Information

NPI Number	:	1013741032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN AMALU PSYD

Provider Business Mailing Address
First Line	:	13961 GILL BROOK LN
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20121-3097
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 E MARKET ST STE 104
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-3001
Country	:	US
Telephone Number	:	703-988-4339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	08/19/2025

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