Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 0810004666 | VA |
Y | 103G00000X | Clinical Psychologist | 0810004666 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810004666 | VA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 0810004666 | VA |
NPI | 1073859211 |
---|---|
Provider Name | Dr. Michelle Rose Blumenthal |
First Address | Leesburg, VA 20176-4544 |
Second Address | Leesburg, VA 20176-4544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2012 |
Last Update Date | 17/12/2012 |