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NPI Code Detail

MEDICARE: DR. BERNADETTE M LANDOLF PH.D.

MEDICARE: DR. BERNADETTE M LANDOLF 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
1103TC0700XClinical Psychologist0810003147VA

General Provider Information

NPI Number : 1538314034
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BERNADETTE M LANDOLF PH.D.
Provider Business Mailing Address
First Line : 12007 SUNRISE VALLEY DR
Second Line : STE 220
City : RESTON
State : VA
Zip : 20191-3446
Country : US
Telephone Number : 703-860-2010
Fax Number : 703-860-2016
Provider Business Practice Location Address
First Line : 12007 SUNRISE VALLEY DR
Second Line : STE 220
City : RESTON
State : VA
Zip : 20191-3446
Country : US
Telephone Number : 703-860-2010
Fax Number : 703-860-2016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2008
Last Update Date : 11/25/2008

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