Active NPI
Wanna Prommart, PSYD
- Psychologist
- Alexandria, VA
National Provider Identifier
1124151014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0810003512
- Practice address
- 205 S Whiting St
Suite 601
Alexandria, VA 22304-2227 - Phone
- (571) 722-8872
- Fax
- (703) 212-8407
- NPI assigned
- Mar 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 0810003512 | VA | Primary |
Addresses
Primary practice location
205 S Whiting St
Suite 601
Alexandria, VA 22304-2227
Mailing address
491 Naylor PL
Alexandria, VA 22304-2227
Phone (571) 722-8872
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11551672 | Other | ACQH | |
| 199902 | Other | ANTHEM BLUE CROSS BLUE SH | |
| 3403124 | Other | CIGNA | |
| 361274 | Other | MHN | |
| 027984 | Other | VMC BEHAVIOR HEALTH SERVI | |
| 3769 | Other | CAREFIRST BLUE CROSS BLUE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810003512 | VA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124151014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "491 NAYLOR PL",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223042227",
"telephone_number": "571-722-8872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 S WHITING ST",
"address_2": "SUITE 601",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223042227",
"telephone_number": "571-722-8872",
"fax_number": "703-212-8407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROMMART",
"first_name": "WANNA",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "VA",
"license": "0810003512",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACQH",
"identifier": "11551672",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS BLUE SH",
"identifier": "199902",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "3403124",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "361274",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VMC BEHAVIOR HEALTH SERVI",
"identifier": "027984",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST BLUE CROSS BLUE",
"identifier": "3769",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Alexandria, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.