Jack Kitaeff, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1070 Issued in VA

Practice address

10560 Main St
Suite 518
Fairfax, VA 22030-7182

Phone

(703) 349-2999

NPI assigned

Apr 11, 2013

Last updated

Sep 29, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

University of Mississippi School of Medicine, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Clinical Psychology Services PCGroup PAC ID 5496718793, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clinical Psychology Services PC

  • Clinical Psychologist
  • Fairfax, VA
  • NPI 1194818054

  DC

  Medicare reassignment Care Compare group NPD
• Fairfax Counseling Services, LLC

  • Community/Behavioral Health Agency
  • Fairfax, VA
  • NPI 1497044150
  NPD (past)

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475107200000",
    "number": "1518300201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9020 FORT CRAIG DR",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "220152115",
            "telephone_number": "703-501-0129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10560 MAIN ST",
            "address_2": "SUITE 518",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220307182",
            "telephone_number": "703-349-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KITAEFF",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-11",
        "last_updated": "2016-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "1070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Kisiedu, OT
• Molly McHale Kisiel, FNP-BC
• Eric William Kisling
• Kismet Psychiatry and Wellness, LLC
• Kissinger Healthcare Enterprises, LLC (Homewatch CareGivers of Fairfax)
• Rebecca Lynne Kivlin, O.D.
• Christine M Klam, NP
• Rosemary Klapac Guimond
• Tabitha Kathleen Kleehammer
• Alyssa Kleeman

• Clinical Psychologist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.