Provider Demographics
NPI:1033489901
Name:CARTY, JILL ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANN
Last Name:CARTY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10907 HUNTER STATION RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-2817
Mailing Address - Country:US
Mailing Address - Phone:703-865-7070
Mailing Address - Fax:
Practice Address - Street 1:5113 LEESBURG PIKE
Practice Address - Street 2:SKYLINE 4, SUITE800A
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041
Practice Address - Country:US
Practice Address - Phone:703-845-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA810003365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical