MEDICARE: DR. HEATHER ABBOTT PSY.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	0810004604	VA

General Provider Information

NPI Number	:	1376890228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER ABBOTT PSY.D.

Provider Business Mailing Address
First Line	:	9255 OLD BEECH CT
Second Line	:
City	:	LORTON
State	:	VA
Zip	:	22079-4700
Country	:	US
Telephone Number	:	703-635-0721
Fax Number	:

Provider Business Practice Location Address
First Line	:	8134 OLD KEENE MILL RD STE 101
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1849
Country	:	US
Telephone Number	:	703-569-8731
Fax Number	:

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

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	08/10/2012

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