MEDICARE: THOMAS JEFFREY NEAL PHD

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	0003150	MD
2	103TC0700X	Clinical Psychologist	0810002252	VA

General Provider Information

NPI Number	:	1174593412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JEFFREY NEAL PHD

Provider Business Mailing Address
First Line	:	5500 HOLMES RUN PKWY
Second Line	:	STE C4
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-2860
Country	:	US
Telephone Number	:	703-379-7350
Fax Number	:	703-379-7352

Provider Business Practice Location Address
First Line	:	5276 DAWES AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-1404
Country	:	US
Telephone Number	:	703-379-3750
Fax Number	:	703-379-7352

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	02/04/2020

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