| Neuropsych Wellness Center, Pc | |
|
3930 Pender Dr Ste 350 Fairfax VA 22030-0989 | |
| (703) 865-8686 | |
| (703) 865-6506 |
| Full Name | Neuropsych Wellness Center, Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3930 Pender Dr Ste 350, Fairfax, Virginia |
| Authorized Official Name and Position | Alok Kumar (PRESIDENT/CEO) |
| Authorized Official Contact | 7036261420 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neuropsych Wellness Center, Pc Po Box 220403 Chantilly VA 20153-0403 Ph: (703) 626-1420 | Neuropsych Wellness Center, Pc 3930 Pender Dr Ste 350 Fairfax VA 22030-0989 Ph: (703) 865-8686 |
| NPI Number | 1588977748 |
|---|---|
| Provider Enumeration Date | 07/16/2010 |
| Last Update Date | 06/02/2015 |
| Medicare PECOS PAC ID | 9335271725 |
|---|---|
| Medicare Enrollment ID | O20100721000168 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588977748 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 0101246802 (Virginia) | Primary |
| Provider Name | Diane Osborne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013916402 PECOS PAC ID: 4486623279 Enrollment ID: I20040928001290 |
| Provider Name | Alok Kumar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639373202 PECOS PAC ID: 6406995588 Enrollment ID: I20100721000221 |
| Provider Name | Cory Alfers |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063667566 PECOS PAC ID: 6709066095 Enrollment ID: I20110302000969 |
| Provider Name | Radha G Agepati |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659532794 PECOS PAC ID: 5890924054 Enrollment ID: I20140210001496 |
| Provider Name | Suvi S Hyytiainen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962873604 PECOS PAC ID: 7810286861 Enrollment ID: I20160516001228 |
| Provider Name | Harish Goyal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558517391 PECOS PAC ID: 7517114648 Enrollment ID: I20170302001364 |
| Provider Name | Vikas Mangewala |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750641668 PECOS PAC ID: 4880991538 Enrollment ID: I20180116002595 |
| Provider Name | Jamie Tobelmann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407204886 PECOS PAC ID: 9234499344 Enrollment ID: I20180212000261 |
| Provider Name | Christina Webster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902206550 PECOS PAC ID: 1850642596 Enrollment ID: I20181217001916 |
| Provider Name | Suzanne Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710272083 PECOS PAC ID: 5092053264 Enrollment ID: I20190213001664 |
| Provider Name | Mimi Tyson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952960924 PECOS PAC ID: 2567790470 Enrollment ID: I20190829002568 |
| Provider Name | Pamela L Herbig Wall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033386446 PECOS PAC ID: 4880971167 Enrollment ID: I20200803000387 |
| Provider Name | Jennifer Mace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861632176 PECOS PAC ID: 6103221098 Enrollment ID: I20210816001194 |
| Provider Name | Jack E Rosenblatt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710085303 PECOS PAC ID: 6608845227 Enrollment ID: I20220524002885 |
| Provider Name | Kaiwen Liu |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326612169 PECOS PAC ID: 0345621132 Enrollment ID: I20220726001227 |
| Provider Name | Erin Sweeney |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497395487 PECOS PAC ID: 8628451655 Enrollment ID: I20220823004050 |
| Provider Name | Stephanie Binter |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902805047 PECOS PAC ID: 3476872573 Enrollment ID: I20221025001373 |
| Provider Name | Jaaska Cather |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255712287 PECOS PAC ID: 7113395070 Enrollment ID: I20221126000107 |
| Provider Name | Anthony John Gage |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124200498 PECOS PAC ID: 1658781760 Enrollment ID: I20230130000848 |
| Provider Name | Amelia Markert Shaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083293278 PECOS PAC ID: 7517347594 Enrollment ID: I20230203002063 |
| Provider Name | Samina S Raja |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023336575 PECOS PAC ID: 8921301748 Enrollment ID: I20231017003920 |
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