Provider Demographics
NPI:1417136599
Name:KRAMER, SHELLEY (PHD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4100
Mailing Address - Country:US
Mailing Address - Phone:703-359-1003
Mailing Address - Fax:
Practice Address - Street 1:4101 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 312
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4100
Practice Address - Country:US
Practice Address - Phone:703-359-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001333103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA951511Medicare UPIN