Jacquelyne M Smalls, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

0810004112 Issued in VA

Practice address

720 N Saint Asaph St
Alexandria, VA 22314-1912

Phone

(703) 746-3485

Fax

(703) 838-5070

NPI assigned

Jun 2, 2009

Sex

Female

Sole proprietor

No

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)

Enrolled

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

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243900800000",
    "number": "1285860593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 N VAN DORN ST",
            "address_2": "APT. #303",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223041071",
            "telephone_number": "703-746-3485",
            "fax_number": "703-838-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 N SAINT ASAPH ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223141912",
            "telephone_number": "703-746-3485",
            "fax_number": "703-838-5070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMALLS",
        "first_name": "JACQUELYNE",
        "middle_name": "M",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-02",
        "last_updated": "2009-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VA",
            "license": "0810004112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004945026",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2009; 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.