MEDICARE: NEUROPSYCHOLOGICAL AND PSYCHOLOGICAL SERVICES, P.C.

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	103G00000X	Clinical Neuropsychologist	0810001828	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B570	OTHER	VA	CARE FIRST BLUE CROSS

General Provider Information

NPI Number	:	1740363415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROPSYCHOLOGICAL AND PSYCHOLOGICAL SERVICES, P.C.

Provider Business Mailing Address
First Line	:	600 CAMERON ST # 307
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2506
Country	:	US
Telephone Number	:	703-283-3325
Fax Number	:	571-418-0078

Provider Business Practice Location Address
First Line	:	600 CAMERON ST # 307
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2506
Country	:	US
Telephone Number	:	703-283-3325
Fax Number	:	571-418-0078

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALEC ANDREW LEBEDUN
Credential	:	PH.D.
Telephone Number	:	703-283-3325

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	04/09/2024

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