MEDICARE: DR. CARYLL JEFFERIES SEMMLER PSY.D.

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	103T00000X	Psychologist	0810004070	VA
2	103TC0700X	Clinical Psychologist	2775	NC
3	103TC0700X	Clinical Psychologist	014694	NY
4	103TC0700X	Clinical Psychologist	0810004070	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BCBS	OTHER	NC	BLUE CROSS BLUE SHEILD
2	344296	OTHER	NC	MANAGED HEALTH NETWORK
3	2202817	OTHER	NC	CIGNA
4	344296	OTHER	NC	MANAGE HEALTH NETWORK
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093710485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARYLL JEFFERIES SEMMLER PSY.D.

Provider Business Mailing Address
First Line	:	5675 OLD FARM LN
Second Line	:
City	:	SUDLEY SPRINGS
State	:	VA
Zip	:	20109-2120
Country	:	US
Telephone Number	:	910-520-0636
Fax Number	:

Provider Business Practice Location Address
First Line	:	5675 STONE RD STE 300
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-1667
Country	:	US
Telephone Number	:	703-829-5597
Fax Number	:

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	02/27/2023

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