MEDICARE: THE ROSE COLORED COUCH LLC

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

General Provider Information

NPI Number	:	1962194894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ROSE COLORED COUCH LLC

Provider Business Mailing Address
First Line	:	1449 N VAN DORN ST # B
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-1920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1449 N VAN DORN ST # B
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-1920
Country	:	US
Telephone Number	:	607-761-1958
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	NAJWA MOHAMED
Credential	:	PSYD
Telephone Number	:	607-761-1958

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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