Family Development Associates, Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY1827 Issued in DC

Legal business name

FAMILY DEVELOPMENT ASSOCIATES, INC.

Practice address

4115 Wisconsin Ave NW Ste 203
Washington, DC 20016-2849

Phone

(202) 955-6381

Fax

(202) 232-2634

NPI assigned

May 10, 2016

Last updated

May 10, 2016By 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

Dr. Theodore Fuller, PH.D.

Title

Psychologist

Phone

(202) 955-6381

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1462838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1487000345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 WISCONSIN AVE NW STE 203",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200162849",
            "telephone_number": "202-955-6381",
            "fax_number": "202-232-2634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 WISCONSIN AVE NW STE 203",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200162849",
            "telephone_number": "202-955-6381",
            "fax_number": "202-232-2634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DEVELOPMENT ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-10",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "202-955-6381",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "DC",
            "license": "PSY1827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Washington, DC
• Providers in Washington, DC by specialty
• Clinical Psychologist in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; 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.