Elizabeth O Fong, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810000304 Issued in VA

Practice address

8140 Ashton Ave
Suite 200
Manassas, VA 20109-5698

Phone

(703) 330-9933

Fax

(703) 368-8454

NPI assigned

Sep 10, 2008

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1221004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221004800000",
    "number": "1245489673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8140 ASHTON AVE",
            "address_2": "SUITE 200",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201095698",
            "telephone_number": "703-330-9933",
            "fax_number": "703-368-8454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8140 ASHTON AVE",
            "address_2": "SUITE 200",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201095698",
            "telephone_number": "703-330-9933",
            "fax_number": "703-368-8454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONG",
        "first_name": "ELIZABETH",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-10",
        "last_updated": "2008-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810000304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Manassas, VA
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2008; 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.