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NPI Code Detail

MEDICARE: RESTON CENTER FOR LEARNING, LLC

MEDICARE: RESTON CENTER FOR LEARNING, 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
1103TB0200XCognitive & Behavioral Psychologist0810003147VA

General Provider Information

NPI Number : 1962795872
Entity Type Code : Organization
Provider Name (Legal Business Name) : RESTON CENTER FOR LEARNING, LLC
Provider Business Mailing Address
First Line : 12007 SUNRISE VALLEY DR STE 220
Second Line :
City : RESTON
State : VA
Zip : 20191-3446
Country : US
Telephone Number : 703-860-2010
Fax Number : 703-860-2016
Provider Business Practice Location Address
First Line : 12007 SUNRISE VALLEY DR STE 220
Second Line :
City : RESTON
State : VA
Zip : 20191-3446
Country : US
Telephone Number : 703-860-2010
Fax Number : 703-860-2016
Authorized Official
Title or Position : OWNER
Name : DR. BERNADETTE LANDOLF
Credential : PH.D.
Telephone Number : 703-860-2010
Provider Enumeration Date : 05/25/2011
Last Update Date : 05/25/2011

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Directions to “RESTON CENTER FOR LEARNING, LLC ” Practice Location

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