Organization
BEAZELL PSYCHOLOGICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEWART BEAZELL LP (CLINICAL PSYCHOLOGIST)
(571) 310-0201
Entity
Organization
Contact information
Practice address
11260 ROGER BACON DR STE 204, RESTON, VA 20190-5252
(571) 310-0201
Mailing address
11260 ROGER BACON DR STE 204, RESTON, VA 20190-5252
(571) 310-0201
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164072146
INDIVIDUAL NPI
VA
Enumeration date
04/12/2022
Last updated
04/12/2022
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