Jack Merenda, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810005120 Issued in VA

Practice address

3921 Blenheim Blvd
Fairfax, VA 22030-2429

Phone

(703) 474-8905

NPI assigned

Jun 17, 2024

Last updated

Jun 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 21, 2024 through Jun 21, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jack a Merenda, Psy.D., Inc.

  • Professional Counselor
  • Burke, VA
  • NPI 1083006365
  NPD (past) Authorized official

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

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1174366330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9306 OLD KEENE MILL RD STE B",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "220154280",
            "telephone_number": "703-474-8905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3921 BLENHEIM BLVD",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302429",
            "telephone_number": "703-474-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERENDA",
        "first_name": "JACK",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810005120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mental Health Services En Espanol LLC (Victoria Transcultural Clinical Center LLC)
• Mental Health Therapy Center - Northern Virginia, LLC
• Saniya Merchant, MD
• Chinelo Mere, PHARMD
• Diana Meredith
• Maria Aryza B Merida, M.A., CCC-SLP
• Victoria Lessinger Merkel, MD
• Robin B Merlino, M.D.
• Joseph Mernagh, M.S.
• Karla Astrid Merola, LPTA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.