Provider Demographics
NPI:1275558454
Name:SCHULMAN, JEFFREY A (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:SCHULMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000B CROWNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1630
Mailing Address - Country:US
Mailing Address - Phone:703-978-3998
Mailing Address - Fax:703-978-7463
Practice Address - Street 1:9000B CROWNWOOD CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1630
Practice Address - Country:US
Practice Address - Phone:703-978-3998
Practice Address - Fax:703-978-7463
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA709248Medicare ID - Type Unspecified