Provider Demographics
NPI:1508075052
Name:MAKSTEIN, NEIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:MAKSTEIN
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 1:7700 LEESBURG PIKE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2615
Mailing Address - Country:US
Mailing Address - Phone:703-560-0055
Mailing Address - Fax:
Practice Address - Street 1:7700 LEESBURG PIKE
Practice Address - Street 2:SUITE 406
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2615
Practice Address - Country:US
Practice Address - Phone:703-560-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1280103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical