Provider Demographics
NPI:1033455803
Name:NEW STRESS CLINIC INC
Entity Type:Organization
Organization Name:NEW STRESS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RAMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRAYAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-674-2742
Mailing Address - Street 1:5194 DAWES AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1402
Mailing Address - Country:US
Mailing Address - Phone:301-674-2742
Mailing Address - Fax:
Practice Address - Street 1:5194 DAWES AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311
Practice Address - Country:US
Practice Address - Phone:301-674-2742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-22
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053989103TP0016X
DCMD21377251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA238232Medicare UPIN