Provider Demographics
NPI:1235723578
Name:MCPHATTER PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:MCPHATTER PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:E ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHATTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-334-3341
Mailing Address - Street 1:PO BOX 66384
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23466-6384
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4445 CORPORATION LN STE 272
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3262
Practice Address - Country:US
Practice Address - Phone:757-231-6835
Practice Address - Fax:757-456-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1720091259Medicaid