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
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