1730815564 NPI number — LAPE PSYCHOLOGY SERVICES PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730815564 NPI number — LAPE PSYCHOLOGY SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAPE PSYCHOLOGY SERVICES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730815564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 GREENSBORO DR STE 900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC LEAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22102-4931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-255-9859
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
276 5TH AVE RM 704
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-255-9859
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2022

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
SHUSHAN
Authorized Official Middle Name:
MELANIE
Authorized Official Title or Position:
OWNER/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
571-255-9859

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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