MEDICARE: DR. CAROLE WARREN SEBENICK PH.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	103TC0700X	Clinical Psychologist	0810000369	VA

General Provider Information

NPI Number	:	1215921143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLE WARREN SEBENICK PH.D.

Provider Business Mailing Address
First Line	:	4001 FAIR RIDGE DR STE 305
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2917
Country	:	US
Telephone Number	:	703-362-9313
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 FAIR RIDGE DR STE 305
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2917
Country	:	US
Telephone Number	:	703-362-9313
Fax Number	:

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	04/08/2014

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