Provider Demographics
NPI:1205016607
Name:WILLIAM R. STIXRUD, PH.D. AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:WILLIAM R. STIXRUD, PH.D. AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STARR
Authorized Official - Middle Name:
Authorized Official - Last Name:STIXRUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-565-0534
Mailing Address - Street 1:8720 GEORGIA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3638
Mailing Address - Country:US
Mailing Address - Phone:301-565-0534
Mailing Address - Fax:301-565-2217
Practice Address - Street 1:8720 GEORGIA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3638
Practice Address - Country:US
Practice Address - Phone:301-565-0534
Practice Address - Fax:301-565-2217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1963103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty