| Charles E. Burt, Ph.d. And Associates, P.c. | |
|
1800 Michael Faraday Dr Ste 206 Reston VA 20190-5312 | |
| (703) 899-3290 | |
| (703) 723-9404 |
| Full Name | Charles E. Burt, Ph.d. And Associates, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 1800 Michael Faraday Dr Ste 206, Reston, Virginia |
| Authorized Official Name and Position | Charles Ernest Burt (PRESIDENT) |
| Authorized Official Contact | 7038993290 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles E. Burt, Ph.d. And Associates, P.c. 22563 Forest Manor Dr Ashburn VA 20148-6900 Ph: (703) 899-3290 | Charles E. Burt, Ph.d. And Associates, P.c. 1800 Michael Faraday Dr Ste 206 Reston VA 20190-5312 Ph: (703) 899-3290 |
| NPI Number | 1518007640 |
|---|---|
| Provider Enumeration Date | 02/07/2007 |
| Last Update Date | 02/29/2020 |
| Certification Date | 02/29/2020 |
| Medicare PECOS PAC ID | 0648348532 |
|---|---|
| Medicare Enrollment ID | O20081006000116 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518007640 | NPI | - | NPPES |
| 031200 | Other | VA | VALUE OPTIONS PROVIDER # |
| 107617 | Other | VA | ANTHEM BXBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 0810001508 (Virginia) | Primary |
| Provider Name | Charles Ernest Burt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043362197 PECOS PAC ID: 0042388050 Enrollment ID: I20081003000593 |
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