MEDICARE: DR. MIA BARTOLETTI 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	103TC0700X	Clinical Psychologist	PSY23834	CA

General Provider Information

NPI Number	:	1588052047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIA BARTOLETTI PSY.D.

Provider Business Mailing Address
First Line	:	3160 PAGE AVE
Second Line	:	UNIT 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-7316
Country	:	US
Telephone Number	:	570-328-1823
Fax Number	:

Provider Business Practice Location Address
First Line	:	3160 PAGE AVE
Second Line	:	UNIT 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-7316
Country	:	US
Telephone Number	:	570-328-1823
Fax Number	:

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

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	01/06/2015

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