MEDICARE: DR. STEPHEN JAMES LALLY PH.D., ABPP

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	1532	DC
2	103T00000X	Psychologist	2529	MD
3	103T00000X	Psychologist	1540	NC
4	103TC0700X	Clinical Psychologist	2182	VA

General Provider Information

NPI Number	:	1306987045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JAMES LALLY PH.D., ABPP

Provider Business Mailing Address
First Line	:	PO BOX 2501
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-0501
Country	:	US
Telephone Number	:	703-527-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 FORT MYER DR
Second Line	:	SUITE 700
City	:	ARLINGTON
State	:	VA
Zip	:	22209-3113
Country	:	US
Telephone Number	:	703-527-1111
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	09/11/2025

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