MEDICARE: DR. JOHN VINCENT NEVINS PHD, LMFT

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	106H00000X	Marriage & Family Therapist		VA

General Provider Information

NPI Number	:	1750571832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN VINCENT NEVINS PHD, LMFT

Provider Business Mailing Address
First Line	:	505 WYTHE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-1917
Country	:	US
Telephone Number	:	703-836-8548
Fax Number	:	703-549-7082

Provider Business Practice Location Address
First Line	:	505 WYTHE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-1917
Country	:	US
Telephone Number	:	703-836-8548
Fax Number	:	703-549-7082

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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