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Organization

SPECIALIZED PSYCHOLOGICAL SERVICES

Active
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Organization

SPECIALIZED PSYCHOLOGICAL SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LAURA EGERTON WERT PH.D. (PRESIDENT)
(804) 264-0966
Entity
Organization

Contact information

Practice address
5821 STAPLES MILL RD, RICHMOND, VA 23228-5427
(804) 264-0966
(804) 264-1029
Mailing address
5821 STAPLES MILL RD, RICHMOND, VA 23228-5427
(804) 264-0966
(804) 264-1029

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810001671
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
002529
VALUE OPTIONS
VA
05
007712332
VA
01
081163
SOUTHERN HEALTH
VA
01
414195
OPTIMUM/MDIPA
VA
01
453170
ANTHEM BLUE CROSS/BLUE SH
VA
Enumeration date
05/19/2006
Last updated
06/16/2010
Update your record

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