NPIMap

Organization Active NPI

Integrated Clinical Concepts

  • Clinical Psychologist
  • Herndon, VA
National Provider Identifier
1447421920
Registry record updated Oct 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
INTEGRATED CLINICAL CONCEPTS
Practice address
481 Carlisle Drive
Suite 112
Herndon, VA 20170
Phone
(703) 481-6001
Fax
(703) 481-5664
NPI assigned
Mar 12, 2008
Last updated
Oct 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2009

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

Authorized official

Name
Judith L Wald, PSYD
Title
Owner
Phone
(703) 481-6001

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X VA
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X Primary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X VA
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

481 Carlisle Drive
Suite 112
Herndon, VA 20170

Mailing address

481 Carlisle Drive
Suite 112
Herndon, VA 20170
Phone (703) 481-6001

Other names 1

  • Associated Clinical Services of Herndon Former legal business name

National Provider Directory

National Provider Directory

Locations

481 Carlisle Dr
Ste 112
Herndon, VA 20170
Phone (703) 481-6001

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256860800000",
    "number": "1447421920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 CARLISLE DRIVE",
            "address_2": "SUITE 112",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "20170",
            "telephone_number": "703-481-6001",
            "fax_number": "703-481-5664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 CARLISLE DRIVE",
            "address_2": "SUITE 112",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "20170",
            "telephone_number": "703-481-6001",
            "fax_number": "703-481-5664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED CLINICAL CONCEPTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-12",
        "last_updated": "2009-10-30",
        "status": "A",
        "authorized_official_last_name": "WALD",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-481-6001",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Associated Clinical Services of Herndon",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Herndon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.