Eduardo M Azcarate, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

0810000952 Issued in VA

Practice address

6201 Leesburg Pike
Falls Church, VA 22044-2201

Phone

(703) 237-0725

NPI assigned

Sep 10, 2012

Last updated

Sep 10, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347235200000",
    "number": "1164771895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 LEESBURG PIKE",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220442201",
            "telephone_number": "703-237-0725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6201 LEESBURG PIKE",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220442201",
            "telephone_number": "703-237-0725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZCARATE",
        "first_name": "EDUARDO",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-10",
        "last_updated": "2012-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "VA",
            "license": "0810000952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12299964",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Wali Azizi, M.D.
• Kevin Andrew Azzam, D.O.
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• Frances Babb

• Clinical Child & Adolescent Psychologist in Falls Church, VA
• Providers in Falls Church, VA by specialty
• Clinical Child & Adolescent Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; 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.