Lakeside Psychological Center PC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

90801000970 Issued in VA

Legal business name

LAKESIDE PSYCHOLOGICAL CENTER PC

Practice address

3076 Brickhouse CT
Virginia Beach, VA 23452-6859

Phone

(757) 486-0909

Fax

(757) 340-7518

NPI assigned

Apr 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Theodore M Stevens, PHDNPI 1790824381

Title

President, Psychologist

Phone

(757) 486-0909

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 5

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

• Theodore M Stevens, PH.D.

  • Clinical Psychologist
  • Virginia Beach, VA
  • NPI 1790824381
  NPD Authorized official
• Catherine Delapp, LCSW

  • Clinical Social Worker
  • Virginia Beach, VA
  • NPI 1891751350
  NPD (past)
• Gloria Kreis Gurdziel, MD

  • Psychiatry Physician
  • Virginia Beach, VA
  • NPI 1437112521
  NPD (past)
• Michael Jan Kubat, LCSW

  • Clinical Social Worker
  • Virginia Beach, VA
  • NPI 1184629164
  NPD (past)
• Karen Z Neymark, LCSW

  • Clinical Social Worker
  • Virginia Beach, VA
  • NPI 1790811040
  NPD (past)

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283299200000",
    "number": "1104044528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3076 BRICKHOUSE CT",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234526859",
            "telephone_number": "757-486-0909",
            "fax_number": "757-340-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3076 BRICKHOUSE CT",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234526859",
            "telephone_number": "757-486-0909",
            "fax_number": "757-340-7518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE PSYCHOLOGICAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2010-09-01",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT, PSYCHOLOGIST",
        "authorized_official_telephone_number": "757-486-0909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "VA",
            "license": "90801000970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1790811040",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATE  NPI",
            "identifier": "1104044528",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Duke T. Laha, PA-C
• Carly Laidlaw
• Julie Laidlaw
• Diana G Laing, RN
• Heather N Laing, OT
• Lakeview Counseling Services, LLC
• Krutika Lakhani, PT
• John Lala
• Emilee C Lam, M.S., CCC-SLP
• Donald Edward Lamarche Jr., MD

• Psychologist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; 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.