Jeanine Ruth Carlson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2073 Issued in VA

Practice address

1487 Chain Bridge Rd
Suite 202
MC Lean, VA 22101-5723

Phone

(703) 919-0917

Fax

(703) 536-4693

NPI assigned

Aug 7, 2007

Last updated

Sep 11, 2012By the provider in NPPES

Sex

Female

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

Other, 1979

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

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.

• Jeanine R. Carlson, PHD, LLC

  • Clinical Psychologist
  • McLean, VA
  • NPI 1144570771

  DC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347321600000",
    "number": "1972794642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1487 CHAIN BRIDGE RD",
            "address_2": "SUITE 202",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221015723",
            "telephone_number": "703-919-0917",
            "fax_number": "703-536-4693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1487 CHAIN BRIDGE RD",
            "address_2": "SUITE 202",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221015723",
            "telephone_number": "703-919-0917",
            "fax_number": "703-536-4693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "JEANINE",
        "middle_name": "RUTH",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-07",
        "last_updated": "2012-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "2073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Care Connect RX LLC (Care Connect Pharmacy)
• Carebuddy of Oakland County Mi, LLC
• Caresave Technologies, Inc. (Homecare.com)
• Carevana Home Health Inc.
• Alison Cariello, LPC, SEP
• Jennifer Maskell Carney, PH.D.
• Lillian Carol Carpio, D.D.S., M.S., PH.D.
• Ethan Lane Carroll
• Shamari Carroll, PT, DPT
• Tajha Carroll, FNP

• Clinical Psychologist in McLean, VA
• Providers in McLean, 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 11, 2012; 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.