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NPI Code Detail

MEDICARE: JOAN KELLEHER

MEDICARE: JOAN KELLEHER
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
1103TS0200XSchool PsychologistPPS-0604867VA

General Provider Information

NPI Number : 1679067904
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOAN KELLEHER
Provider Business Mailing Address
First Line : 8270 WILLOW OAKS CORPORATE DR
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-4530
Country : US
Telephone Number : 571-423-4250
Fax Number :
Provider Business Practice Location Address
First Line : 8270 WILLOW OAKS CORPORATE DR
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-4511
Country : US
Telephone Number : 571-423-4250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2018
Last Update Date : 12/10/2025

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Directions to “ JOAN KELLEHER ” Practice Location

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