MEDICARE: DR. HENRY PREMPEH 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
1	103TC0700X	Clinical Psychologist	PSY1001119	DC
2	103TC0700X	Clinical Psychologist	0810005641	VA

General Provider Information

NPI Number	:	1861850836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY PREMPEH PH.D

Provider Business Mailing Address
First Line	:	1655 FORT MYER DR STE 350
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-3118
Country	:	US
Telephone Number	:	202-780-6103
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 FORT MYER DR STE 350
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-3118
Country	:	US
Telephone Number	:	202-780-6103
Fax Number	:

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

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	06/26/2023

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