Fountain of Life LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810002980 Issued in VA

Legal business name

FOUNTAIN OF LIFE LLC

Practice address

450 W Broad St Ste 211
Falls Church, VA 22046-3318

Phone

(571) 277-4919

Fax

(703) 241-1122

NPI assigned

Mar 14, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Lisa Klewicki, PH.D.NPI 1265989503

Title

Clinical Psychologist

Phone

(571) 277-4919

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Klewicki, PH.D.

  • Clinical Psychologist
  • Falls Church, VA
  • NPI 1265989503
  NPD (past) Authorized official

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

{
    "created_epoch": "1489449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489449600000",
    "number": "1396286019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 W BROAD ST STE 211",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220463318",
            "telephone_number": "571-277-4919",
            "fax_number": "703-241-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 W BROAD ST STE 211",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220463318",
            "telephone_number": "571-277-4919",
            "fax_number": "703-241-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-14",
        "last_updated": "2017-03-14",
        "status": "A",
        "authorized_official_last_name": "KLEWICKI",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "571-277-4919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810002980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Quinzi Forster, PT, DPT
• David John Forster, MD
• Anna Fortin, DPT COMT CKTP
• Ashley Victoria Foster
• Michael B Foster, M.D.
• Four Seasons Home Health, LLC
• Amy Fourney
• Alisa Fowler
• Mark D Fowler, M.D.
• Eduardo R Fox, M.D.

• Clinical Psychologist in Falls Church, VA
• Providers in Falls Church, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; 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.