MEDICARE: DR. JOHN HASKELL RISKIND 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	103T00000X	Psychologist	0810002321	VA

General Provider Information

NPI Number	:	1871652008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN HASKELL RISKIND PH.D.

Provider Business Mailing Address
First Line	:	8550 ARLINGTON BLVD
Second Line	:	310
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4634
Country	:	US
Telephone Number	:	703-280-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	8550 ARLINGTON BLVD
Second Line	:	310
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4634
Country	:	US
Telephone Number	:	703-280-8060
Fax Number	:

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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