Individual
DR. ANTONIA MARIE REPOLLET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
5244 LYNGATE CT STE 200, BURKE, VA 22015-1631
(703) 910-2577
Mailing address
5244 LYNGATE CT STE 200, BURKE, VA 22015-1631
(703) 910-2577
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
025710
NY
103T00000X
Psychologist
Primary
35SI00712100
NJ
103T00000X
Psychologist
PSY-PSY-LIC-5083
MT
103TC0700X
Clinical Psychologist
0810008547
VA
103TS0200X
School Psychologist
1027950
NJ
Other
Enumeration date
09/28/2020
Last updated
09/10/2024
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