MEDICARE: SAFE HARBOR 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
1	103T00000X	Psychologist	0810004090	VA

General Provider Information

NPI Number	:	1518387034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE HARBOR PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	11409 FORT SARATOGA COURT
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744
Country	:	US
Telephone Number	:	202-596-6640
Fax Number	:

Provider Business Practice Location Address
First Line	:	3331 DUKE STREET
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314
Country	:	US
Telephone Number	:	202-596-6640
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	RACHEL SCHUCHART
Credential	:	PSYD
Telephone Number	:	202-596-6640

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	04/23/2014

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