Individual provider Active NPI

Ivelisse Morales-Rios

  • Clinical Psychologist
  • Leesburg, VA
National Provider Identifier
1710225917
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1710225917 Issued in VA
Practice address
102 Heritage Way NE
Leesburg, VA 20176-4544
Phone
(703) 771-5100
NPI assigned
Jan 22, 2013
Last updated
Aug 1, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 1710225917 VA Primary

Addresses

Primary practice location

102 Heritage Way NE
Leesburg, VA 20176-4544

Mailing address

102 Heritage Way NE
Leesburg, VA 20176-4544
Phone (703) 771-5100

Other identifiers 7

IdentifierTypeStateIssuer
8443OtherMABMC/BEACON
997303OtherMANETWORK HEALTH
042622756OtherMACOMMONWEALTH
1303295MedicaidMA
1022610OtherMANHP
12529OtherMAHEATLH NEW ENGLAND
1303295OtherMAMBHP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160315002492 WV Practitioner - Psychologist Billing Independently 6204132335
I20160610001275 VA Practitioner - Clinical Psychologist 6204132335 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1710225917VAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Shenandoah Valley Medical System, Inc. CurrentSince Nov 21, 2015 Accepting new patients
County of Loudoun, Virginia CurrentSince Aug 14, 2025 Accepting new patients
County of Loudoun, Virginia CurrentSince Aug 14, 2025 Accepting new patients
Gandara Mental Health Center Inc PastSince May 27, 2000 Accepting new patients
Shenandoah Valley Medical System, Inc. Past Accepting new patients

Locations

102 Heritage Way NE
Ste 102
Leesburg, VA 20176
Phone (703) 771-5155

102 Heritage Way NE
Ste 302
Leesburg, VA 20176
Phone (703) 771-5155

906 Trailview Blvd SE
Ste C
Leesburg, VA 20175
Phone (571) 583-3323

21641 Ridgetop Cir
Ste 210
Sterling, VA 20166
Phone (571) 541-8727

99 Tavern Rd
Martinsburg, WV 25401
Phone (304) 263-7023

Interoperability endpoints

  • Direct secure messaging: ivelisse.morales-rios.1@32629.direct.athenahealth.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1358812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1710225917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 HERITAGE WAY NE",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201764544",
            "telephone_number": "703-771-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 HERITAGE WAY NE",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201764544",
            "telephone_number": "703-771-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORALES-RIOS",
        "first_name": "IVELISSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-22",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "1710225917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BMC/BEACON",
            "identifier": "8443",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "997303",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMONWEALTH",
            "identifier": "042622756",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303295",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NHP",
            "identifier": "1022610",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEATLH NEW ENGLAND",
            "identifier": "12529",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MBHP",
            "identifier": "1303295",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, VA

Sources for this page

Verify at the official NPI Registry.