Active NPI
Jacob Levi Priluck, PSYD
- Clinical Neuropsychologist
- Springfield, VA
National Provider Identifier
1992289425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 0810006056
- Practice address
- 6120 Brandon Ave
Springfield, VA 22150-2522 - Phone
- (917) 783-0634
- NPI assigned
- Sep 20, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810006056 | VA | |
| Clinical Neuropsychologist | 103G00000X | 0810006056 | VA | Primary |
Addresses
Primary practice location
6120 Brandon Ave
Springfield, VA 22150-2522
Mailing address
1501 Sulgrave Ave Ste 209
Baltimore, MD 21209-3650
Phone (917) 783-0634
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674086400000",
"number": "1992289425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 SULGRAVE AVE STE 209",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212093650",
"telephone_number": "917-783-0634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6120 BRANDON AVE",
"city": "SPRINGFIELD",
"state": "VA",
"postal_code": "221502522",
"telephone_number": "917-783-0634"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRILUCK",
"first_name": "JACOB",
"middle_name": "LEVI",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-09-20",
"last_updated": "2023-01-19",
"certification_date": "2023-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810006056",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "VA",
"license": "0810006056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.