Indian River Psychological Associates, P.C.

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

Legal business name

INDIAN RIVER PSYCHOLOGICAL ASSOCIATES, P.C.

Practice address

6477 College Park SQ
Suite 302
Virginia Beach, VA 23464-3611

Phone

(757) 424-0100

Fax

(757) 424-5623

NPI assigned

Nov 8, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. I. Kimberlee Chucker, LCSW

Title

President

Phone

(757) 424-0100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ingrid Kimberlee Chucker, L.C.S.W.

  • Clinical Social Worker
  • Virginia Beach, VA
  • NPI 1033222518
  Medicare reassignment Care Compare group
• Daniel T Walter, PSYD

  • Clinical Psychologist
  • Portsmouth, VA
  • NPI 1588647283
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316016645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6477 COLLEGE PARK SQ",
            "address_2": "SUITE 302",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234643611",
            "telephone_number": "757-424-0100",
            "fax_number": "757-424-5623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6477 COLLEGE PARK SQ",
            "address_2": "SUITE 302",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234643611",
            "telephone_number": "757-424-0100",
            "fax_number": "757-424-5623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN RIVER PSYCHOLOGICAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHUCKER",
        "authorized_official_first_name": "I.",
        "authorized_official_middle_name": "KIMBERLEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-424-0100",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cognitive & Behavioral Psychologist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Cognitive & Behavioral Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.