Sarunporn (Jay) Sirikietsoong, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

0810006183 Issued in VA

Practice address

6120 Brandon Ave Ste 315
Springfield, VA 22150-2504

Phone

(541) 514-9884

NPI assigned

Oct 1, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Potomac Center Inc

  • Professional Counselor
  • Alexandria, VA
  • NPI 1457403099

  DC

  Medicare reassignment NPD

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

{
    "created_epoch": "1285891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559692800000",
    "number": "1871802314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6120 BRANDON AVE STE 315",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221502504",
            "telephone_number": "703-283-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6120 BRANDON AVE STE 315",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221502504",
            "telephone_number": "541-514-9884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIRIKIETSOONG",
        "first_name": "SARUNPORN (JAY)",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-01",
        "last_updated": "2019-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VA",
            "license": "0810006183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Priya Singh, MD
• Rubina Mittal Singh, PHARM.D.
• Tripta Resham Singh, MBBS
• Preetee Singhal, PT
• Allyson M. Sipes, PSYD
• Sirius Eye Care PLLC
• Richard B Sisson, MD
• Afton Sizemore
• SJH Behavioral Consulting LLC
• Dorothy Slocum

• Psychologist in Springfield, VA
• Providers in Springfield, VA by specialty
• Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.