Active NPI
Antonia Marie Repollet, PSYD
- Psychologist
- Burke, VA
National Provider Identifier
1457968026
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 35SI00712100
- Practice address
- 5244 Lyngate CT Ste 200
Burke, VA 22015-1631 - Phone
- (703) 910-2577
- NPI assigned
- Sep 28, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 025710 | NY | |
| Psychologist | 103T00000X | PSY-PSY-LIC-5083 | MT | |
| Clinical Psychologist | 103TC0700X | 0810008547 | VA | |
| School Psychologist | 103TS0200X | 1027950 | NJ | |
| Psychologist | 103T00000X | 35SI00712100 | NJ | Primary |
Addresses
Primary practice location
5244 Lyngate CT Ste 200
Burke, VA 22015-1631
Mailing address
5244 Lyngate CT Ste 200
Burke, VA 22015-1631
Phone (703) 910-2577
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 14, 2024 through Oct 14, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-PSY-LIC-5083 | MT | MD | Psychologist |
| 35SI00712100 | NJ | MD | Psychologist |
| 0810008547 | VA | MD | Clinical Psychologist |
| 1027950 | NJ | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725926400000",
"number": "1457968026",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5244 LYNGATE CT STE 200",
"city": "BURKE",
"state": "VA",
"postal_code": "220151631",
"telephone_number": "703-910-2577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5244 LYNGATE CT STE 200",
"city": "BURKE",
"state": "VA",
"postal_code": "220151631",
"telephone_number": "703-910-2577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REPOLLET",
"first_name": "ANTONIA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-28",
"last_updated": "2024-09-10",
"certification_date": "2024-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "025710",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MT",
"license": "PSY-PSY-LIC-5083",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810008547",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NJ",
"license": "1027950",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "35SI00712100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.