1720459746 NPI number — DR. MICHELLE RAD LCP, PSYD, MA

Table of content: MR. JOSEPH ZAMARIA (NPI 1184957359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720459746 NPI number — DR. MICHELLE RAD LCP, PSYD, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAD
Provider First Name:
MICHELLE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LCP, PSYD, MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAD
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCP, PSYD, MA, APIT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720459746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43803 MICHENER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20147-5807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-937-3183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43803 MICHENER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147-5807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-443-4924
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  0810005315 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0810005315 . This is a "LICENSED CLINICAL PSYCHOLOGIST, VA BOARD OF PSYCHOLOGY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".