MEDICARE: DR. NNAMDI GLENN OHAERI SR. 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	PSY.0004342	CO
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1184900839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NNAMDI GLENN OHAERI SR. PSYD

Provider Business Mailing Address
First Line	:	2300 JUNIPER LN
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3376
Country	:	US
Telephone Number	:	909-730-6218
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS ABRAHAM LINCOLN
Second Line	:	CVN 72 UNIT 100349
City	:	FPO
State	:	AE
Zip	:	09520
Country	:	US
Telephone Number	:	909-730-6218
Fax Number	:

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

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	11/22/2016

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