Nancy Wachtenheim, L.C.S.W.

Primary specialty

SpecialistTaxonomy code 174400000X

License

0904001780 Issued in VA

Practice address

3923 Blenheim Blvd.
Suite 63-D
Fairfax, VA 22030

Phone

(703) 277-7668

NPI assigned

Mar 10, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2013 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• J.Lawrence Jamieson,PH.D.,P.C.

  • Clinical Psychologist
  • Fairfax, VA
  • NPI 1841420759
  NPD (past)

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

{
    "created_epoch": "1173484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1649302142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3923 BLENHEIM BLVD.",
            "address_2": "SUITE 63-D",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22030",
            "telephone_number": "703-277-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3923 BLENHEIM BLVD.",
            "address_2": "SUITE 63-D",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22030",
            "telephone_number": "703-277-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACHTENHEIM",
        "first_name": "NANCY",
        "name_prefix": "Ms.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-10",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "VA",
            "license": "0904001780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "210562",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "1352",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Quan Duh Mayn Vu, M.D.
• Thi Anh Vu, L.AC.
• Thuy-Anh Hoang Vu, MD
• Marianne Beare Vyas, PHD, ANP-BC
• Nilesh A Vyas, M.D.
• Ashley Wade-Vuturo, M.D.
• Dorien Wade
• Jonathan Oliver Wade, LPC
• Karianne Lynne Wade
• Raymond C Wadlow, MD

• Specialist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Specialist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.