MEDICARE: DR. CATHERINE E WANAMAKER 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	103T00000X	Psychologist	0810002412	VA

General Provider Information

NPI Number	:	1336233428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE E WANAMAKER PH. D.

Provider Business Mailing Address
First Line	:	801 CHILDRENS CENTER RD SW
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-2545
Country	:	US
Telephone Number	:	703-777-3485
Fax Number	:	703-777-4887

Provider Business Practice Location Address
First Line	:	801 CHILDRENS CENTER RD SW
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-2545
Country	:	US
Telephone Number	:	703-777-3485
Fax Number	:	703-777-4887

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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