Jeanine R. Carlson, PHD, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

VA2078 Issued in VA

Legal business name

JEANINE R. CARLSON, PHD, LLC

Practice address

1487 Chain Bridge Rd Ste 202
MC Lean, VA 22101-5723

Phone

(703) 919-0917

NPI assigned

Sep 11, 2012

Organization subpart

No

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

Authorized official

Name

Jeanine R Carlson, PHDNPI 1972794642

Title

Owner

Phone

(703) 919-0917

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

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, and the practitioner matching its NPPES authorized official.

• Jeanine Ruth Carlson, PH.D.

  • Clinical Psychologist
  • McLean, VA
  • NPI 1972794642

  DC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347321600000",
    "number": "1144570771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1487 CHAIN BRIDGE RD STE 202",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221015723",
            "telephone_number": "703-919-0917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1487 CHAIN BRIDGE RD STE 202",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221015723",
            "telephone_number": "703-919-0917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEANINE R. CARLSON, PHD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-11",
        "last_updated": "2012-09-11",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "JEANINE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-919-0917",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "VA2078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paola R Jarvis
• Praveen Jaspal, M.D
• Claire Louise Jasper-Crafter, EDD
• Omar Javery
• Abigail Jean, RBT
• Matthew B Jefferson, MASSAGE THERAPIST
• Toni Jeffries
• Daphne C Jenkins, FNP-BC
• Jennifer Weaver and Associates, PLLC (Weaver and Associates, PLLC)
• Charles David Jensen, D.D.S.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; 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.