Provider Demographics
NPI:1477009918
Name:YOUSEFI, MELANIE (PMHNP-BC, DNP)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:YOUSEFI
Suffix:
Gender:F
Credentials:PMHNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11198 LEE HWY STE D2
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5009
Mailing Address - Country:US
Mailing Address - Phone:703-783-2474
Mailing Address - Fax:703-783-7459
Practice Address - Street 1:11198 LEE HWY STE D2
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5009
Practice Address - Country:US
Practice Address - Phone:703-783-2474
Practice Address - Fax:703-783-7459
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001231859163W00000X
VA0024173640363LP0808X
VA0024176340363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477009918OtherNPI