Provider Demographics
NPI:1275689390
Name:STEJSKAL, WILLIAM JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:STEJSKAL
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 1:4320 PRINCE WILLIAM PKWY STE 109
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8100
Mailing Address - Country:US
Mailing Address - Phone:703-680-4200
Mailing Address - Fax:703-680-5011
Practice Address - Street 1:4320 PRINCE WILLIAM PKWY STE 109
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8100
Practice Address - Country:US
Practice Address - Phone:703-680-4200
Practice Address - Fax:703-680-5011
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1475103TF0200X
VA0810001635103TF0200X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA145746OtherANTHEM BCBS