Individual
DR. JACOB LEVI PRILUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
6120 BRANDON AVE, SPRINGFIELD, VA 22150-2522
(917) 783-0634
Mailing address
1501 SULGRAVE AVE STE 209, BALTIMORE, MD 21209-3650
(917) 783-0634
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
0810006056
VA
103TC0700X
Clinical Psychologist
0810006056
VA
Other
Enumeration date
09/20/2018
Last updated
01/19/2023
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