Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 0803000281 | VA |
Y | 103T00000X | Psychologist | 0803000281 | VA |
N | 103TS0200X | School Psychologist |
NPI | 1003499393 |
---|---|
Provider Name | Jason Northrup |
First Address | Chevy Chase, MD 20815-7007 |
Second Address | Arlington, VA 22203-1546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2021 |
Last Update Date | 04/05/2021 |