NPIMap

Organization Active NPI

Jack a Merenda, Psy.D., Inc.

  • Professional Counselor
  • Burke, VA
National Provider Identifier
1083006365
Registry record updated Feb 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0810005120 Issued in VA
Legal business name
JACK A MERENDA, PSY.D., INC.
Practice address
9306 Old Keene Mill Rd
B
Burke, VA 22015-4280
Phone
(703) 474-8905
NPI assigned
Feb 24, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jack Allen Merenda, PSY.D.NPI 1174366330
Title
President
Phone
(703) 474-8905

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X 0810005120 VA Primary

Addresses

Primary practice location

9306 Old Keene Mill Rd
B
Burke, VA 22015-4280

Mailing address

9306 Old Keene Mill Rd
B
Burke, VA 22015-4280
Phone (703) 474-8905

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424736000000",
    "number": "1083006365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9306 OLD KEENE MILL RD",
            "address_2": "B",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "220154280",
            "telephone_number": "703-474-8905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9306 OLD KEENE MILL RD",
            "address_2": "B",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "220154280",
            "telephone_number": "703-474-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK A MERENDA, PSY.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-24",
        "last_updated": "2015-02-24",
        "status": "A",
        "authorized_official_last_name": "MERENDA",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-474-8905",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0810005120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.