| NPI | 1528675212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY ANDREW ELLSWORTH Clinical Psychologist 571-317-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| 1041C0700X Social Worker, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2020-09-26 |
| Last Update Date | 2020-09-26 |