NPIMap

Organization Active NPI

Supportive Care of Virginia LLC

  • Clinical Psychologist
  • Colonial Heights, VA
National Provider Identifier
1801485354
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SUPPORTIVE CARE OF VIRGINIA LLC
Practice address
831 E Ellerslie Ave
Colonial Heights, VA 23834-1720
Phone
(718) 298-7345
NPI assigned
Jan 11, 2021
Last updated
Jan 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Authorized official

Name
Raphael Lichtschein
Title
President
Phone
(718) 298-4375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X NU Primary

Addresses

Primary practice location

831 E Ellerslie Ave
Colonial Heights, VA 23834-1720

Mailing address

27 Randolph Rd
Howell, NJ 07731-8611
Phone (718) 298-4375

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210208000520 VA Part B Supplier - Clinic/Group Practice 2961816731 Receives reassigned benefits from 36 practitioners
Practice locations: Colonial Heights, VA
O20240326000185 DC Part B Supplier - Clinic/Group Practice 2961816731 Receives reassigned benefits from 1 practitioner
Practice locations: Dunn Loring, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1801485354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 RANDOLPH RD",
            "city": "HOWELL",
            "state": "NJ",
            "postal_code": "077318611",
            "telephone_number": "718-298-4375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 E ELLERSLIE AVE",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238341720",
            "telephone_number": "718-298-7345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE CARE OF VIRGINIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-11",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A",
        "authorized_official_last_name": "LICHTSCHEIN",
        "authorized_official_first_name": "RAPHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-298-4375"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colonial Heights, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.