| Clinical Psychology Services Pc | |
|
11130 Fairfax Blvd Ste 305 Fairfax VA 22030-5035 | |
| (703) 691-1326 | |
| (703) 691-3553 |
| Full Name | Clinical Psychology Services Pc |
|---|---|
| Speciality | Psychologist |
| Location | 11130 Fairfax Blvd, Fairfax, Virginia |
| Authorized Official Name and Position | David W Ruxer (PRESIDENT) |
| Authorized Official Contact | 7036911326 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinical Psychology Services Pc 11130 Fairfax Blvd Ste 305 Fairfax VA 22030-5035 Ph: (703) 691-1326 | Clinical Psychology Services Pc 11130 Fairfax Blvd Ste 305 Fairfax VA 22030-5035 Ph: (703) 691-1326 |
| NPI Number | 1194818054 |
|---|---|
| Provider Enumeration Date | 10/02/2006 |
| Last Update Date | 04/22/2013 |
| Medicare PECOS PAC ID | 5496718793 |
|---|---|
| Medicare Enrollment ID | O20041108000889 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194818054 | NPI | - | NPPES |
| 007799195 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jennie L Crim |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013963347 PECOS PAC ID: 3274570684 Enrollment ID: I20050415000698 |
| Provider Name | David W Ruxer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073560967 PECOS PAC ID: 5799709812 Enrollment ID: I20110323000437 |
| Provider Name | Jeanne M. Marquis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063440931 PECOS PAC ID: 9638354483 Enrollment ID: I20110421000376 |
| Provider Name | Susan A Murdock |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902845415 PECOS PAC ID: 9133304892 Enrollment ID: I20110425000384 |
| Provider Name | Steven B Tunick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972531846 PECOS PAC ID: 3678758281 Enrollment ID: I20110426000183 |
| Provider Name | Susan A Etkind |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548585334 PECOS PAC ID: 9335366574 Enrollment ID: I20140811002561 |
| Provider Name | Lauren Wall |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578970224 PECOS PAC ID: 3173742236 Enrollment ID: I20151007001394 |
| Provider Name | Jack Nmi Kitaeff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518300201 PECOS PAC ID: 6608132261 Enrollment ID: I20171114003674 |
| Provider Name | Diane C Wagner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194211540 PECOS PAC ID: 9830448844 Enrollment ID: I20180824001661 |
| Provider Name | Megan L Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134619968 PECOS PAC ID: 5799165304 Enrollment ID: I20220629000482 |
| Provider Name | Jon Howard Siegel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124149513 PECOS PAC ID: 2860437118 Enrollment ID: I20220629002547 |
| Provider Name | Alisa S Talkington |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548354343 PECOS PAC ID: 1658473319 Enrollment ID: I20220706001717 |
| Provider Name | William Steven Rybicki |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1104004530 PECOS PAC ID: 0446338636 Enrollment ID: I20220708001451 |
| Provider Name | Mary Lou Rubert |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427400472 PECOS PAC ID: 4688084221 Enrollment ID: I20220913002209 |
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