Provider Demographics
NPI:1467586578
Name:BERENDT, ELIZABETH ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:BERENDT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:BERENDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:10560 MAIN ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7182
Mailing Address - Country:US
Mailing Address - Phone:703-691-1326
Mailing Address - Fax:703-691-3553
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:SUITE 507
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7182
Practice Address - Country:US
Practice Address - Phone:703-691-1326
Practice Address - Fax:703-691-3553
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14503103TC0700X
NM847103TC0700X
VA0810004235103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical