NPIMap

Organization Active NPI

Independence Psychotherapy Services LLC

  • Clinical Psychologist
  • Williamsburg, VA
National Provider Identifier
1306235783
Registry record updated Jan 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0810004468 Issued in VA
Legal business name
INDEPENDENCE PSYCHOTHERAPY SERVICES LLC
Practice address
215 McLaws Cir
Suite 1
Williamsburg, VA 23185-5799
Phone
(757) 345-6428
Fax
(757) 345-6808
NPI assigned
Jan 22, 2015
Last updated
Jan 22, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2015

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

Authorized official

Name
Dr. Linda Bourdon Rein, ED.D., LCP
Title
Director
Phone
(757) 345-6428

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X 07010005880 VA
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X 08701003392 VA
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 0810004468 VA Primary

Addresses

Primary practice location

215 McLaws Cir
Suite 1
Williamsburg, VA 23185-5799

Mailing address

215 McLaws Cir
Suite 1
Williamsburg, VA 23185-5799
Phone (757) 345-6428

Other identifiers 1

IdentifierTypeStateIssuer
1417232802OtherVAINDEPENDENCE CHILD THERAPY SERVICES LLC

National Provider Directory

National Provider Directory

Locations

215 McLaws Cir
Ste 1
Williamsburg, VA 23185
Phone (757) 345-6428

NPI Registry JSON

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

{
    "created_epoch": "1421884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421884800000",
    "number": "1306235783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 MCLAWS CIR",
            "address_2": "SUITE 1",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231855799",
            "telephone_number": "757-345-6428",
            "fax_number": "757-345-6808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 MCLAWS CIR",
            "address_2": "SUITE 1",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231855799",
            "telephone_number": "757-345-6428",
            "fax_number": "757-345-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE PSYCHOTHERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-22",
        "last_updated": "2015-01-22",
        "status": "A",
        "authorized_official_last_name": "REIN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "BOURDON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "757-345-6428",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D., LCP"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "VA",
            "license": "07010005880",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "VA",
            "license": "08701003392",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810004468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE CHILD THERAPY SERVICES LLC",
            "identifier": "1417232802",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; 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.