Mind Body Connection, Inc

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810004824 Issued in VA

Legal business name

MIND BODY CONNECTION, INC

Practice address

493 Blackwell Rd
Suite 203
Warrenton, VA 20186

Phone

(571) 364-3095

Fax

(540) 341-7091

NPI assigned

Sep 13, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Anupama T Kommu, PSYDNPI 1518392760

Title

Licensed Clinical Psychologist

Phone

(571) 364-3095

Specialties & licenses 1

Addresses

Other names 1

• Anupama Kommu Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

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

• Anupama T Kommu, PSYD

  • Clinical Psychologist
  • Warrenton, VA
  • NPI 1518392760
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1379030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572307200000",
    "number": "1134554793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4441 CORRAL RD",
            "city": "WARRENTON",
            "state": "VA",
            "postal_code": "20187",
            "telephone_number": "571-364-3095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 BLACKWELL RD",
            "address_2": "SUITE 203",
            "city": "WARRENTON",
            "state": "VA",
            "postal_code": "20186",
            "telephone_number": "571-364-3095",
            "fax_number": "540-341-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY CONNECTION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-13",
        "last_updated": "2019-10-29",
        "status": "A",
        "authorized_official_last_name": "KOMMU",
        "authorized_official_first_name": "ANUPAMA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "571-364-3095",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810004824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anupama Kommu",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Anupama Kommu",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gwendolyn Miller
• Juliana Forrester Miller, MSD
• Michaela Fallon Miller, DO
• Robert Alexander Miller, DMD
• Karen B Millerson, DSCPT
• Jorge Minera, M.D.
• Soledad N. Minera, DDS
• Dimitar Mirinski, RPH
• Marissa Victoria Mitrovic, FNP-BC
• Anuj Mittal, PHARMD.

• Clinical Psychologist in Warrenton, VA
• Providers in Warrenton, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.