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NPI Code Detail

MEDICARE: SPECIALIZED PSYCHOLOGICAL SERVICES

MEDICARE: SPECIALIZED PSYCHOLOGICAL SERVICES
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
1103TC0700XClinical Psychologist0810001671VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1002529OTHERVAVALUE OPTIONS
2081163OTHERVASOUTHERN HEALTH
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4414195OTHERVAOPTIMUM/MDIPA
5453170OTHERVAANTHEM BLUE CROSS/BLUE SH

General Provider Information

NPI Number : 1497708374
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECIALIZED PSYCHOLOGICAL SERVICES
Provider Business Mailing Address
First Line : 5821 STAPLES MILL RD
Second Line :
City : RICHMOND
State : VA
Zip : 23228-5427
Country : US
Telephone Number : 804-264-0966
Fax Number : 804-264-1029
Provider Business Practice Location Address
First Line : 5821 STAPLES MILL RD
Second Line :
City : RICHMOND
State : VA
Zip : 23228-5427
Country : US
Telephone Number : 804-264-0966
Fax Number : 804-264-1029
Authorized Official
Title or Position : PRESIDENT
Name : DR. LAURA EGERTON WERT
Credential : PH.D.
Telephone Number : 804-264-0966
Provider Enumeration Date : 05/19/2006
Last Update Date : 06/16/2010

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1619983038 — DR. ANNE MARIE SITARZ PH.D.
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Directions to “SPECIALIZED PSYCHOLOGICAL SERVICES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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