NPIMap

Organization Active NPI

Woodbridge Psychological Associates, P.C.

  • Clinical Psychologist
  • Woodbridge, VA
National Provider Identifier
1457407009
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0810011635 Issued in VA
Legal business name
WOODBRIDGE PSYCHOLOGICAL ASSOCIATES, P.C.
Practice address
2200 Opitz Blvd Ste 105B
Woodbridge, VA 22191-3342
Phone
(703) 491-0042
Fax
(703) 491-9200
NPI assigned
Jan 26, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. William Joseph Stejskal, PHD
Title
President
Phone
(703) 491-0042

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 0810011635 VA Primary

Addresses

Primary practice location

2200 Opitz Blvd Ste 105B
Woodbridge, VA 22191-3342

Mailing address

2200 Opitz Blvd Ste 105B
Woodbridge, VA 22191-3342
Phone (703) 491-0042

Other identifiers 1

IdentifierTypeStateIssuer
145747OtherVAANTHEM BCBS

Other names 1

  • WPA Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170609001022 VA Part B Supplier - Clinic/Group Practice 1052689379 Receives reassigned benefits from 9 practitioners
Practice locations: MC Lean, VA; Woodbridge, VA

National Provider Directory

National Provider Directory

Locations

4320 Prince William Pkwy
Ste 109
Woodbridge, VA 22192
Phone (703) 680-4200

Practitioners & affiliated clinicians

Practitioners 10

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": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457407009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 OPITZ BLVD STE 105B",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913342",
            "telephone_number": "703-491-0042",
            "fax_number": "703-491-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 OPITZ BLVD STE 105B",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913342",
            "telephone_number": "703-491-0042",
            "fax_number": "703-491-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBRIDGE PSYCHOLOGICAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STEJSKAL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-491-0042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810011635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "145747",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WPA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Woodbridge, VA

Sources for this page

  • 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.