Provider Demographics
NPI:1093787970
Name:WALD, BRIAN K (PSY D)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:WALD
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLUMBUS CTR
Mailing Address - Street 2:STE 600
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6722
Mailing Address - Country:US
Mailing Address - Phone:757-333-7501
Mailing Address - Fax:757-490-7804
Practice Address - Street 1:1 COLUMBUS CTR
Practice Address - Street 2:STE 600
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6722
Practice Address - Country:US
Practice Address - Phone:757-333-7501
Practice Address - Fax:757-490-7804
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001650103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
087278OtherMAGELLAN
275889OtherMAMSI
000775OtherVALUE OPTIONS
380798OtherANTHEM HEALTH KEEPERS
C02527OtherMCARE GROUP
080411OtherSENTARA OPTIMA
VA007708491Medicaid
380798OtherANTHEM PPO BCBS
43220OtherCIGNA
680009370OtherMCARE RAILROAD
258293OtherMANAGED HEALTH NETWORK
087278OtherMAGELLAN
VA9914Medicare PIN