MEDICARE: DR. MICHAEL P JOLKOVSKI 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	0810001826	VA
2	103TC1900X	Counseling Psychologist	0810001826	VA
3	103TP0814X	Psychoanalysis Psychologist	0810001826	VA
4	103T00000X	Psychologist	0810001826	VA

General Provider Information

NPI Number	:	1417930298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL P JOLKOVSKI PH.D.

Provider Business Mailing Address
First Line	:	500 N WASHINGTON ST
Second Line	:	SUITE 101
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3514
Country	:	US
Telephone Number	:	703-533-8677
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N WASHINGTON ST
Second Line	:	SUITE 101
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3514
Country	:	US
Telephone Number	:	703-533-8677
Fax Number	:

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	09/11/2025

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