Provider Demographics
NPI:1518401470
Name:TYSONS PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:TYSONS PSYCHOLOGY, PLLC
Other - Org Name:TYSONS PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIORILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-674-6225
Mailing Address - Street 1:8027 LEESBURG PIKE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:TYSONS
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2701
Mailing Address - Country:US
Mailing Address - Phone:703-674-6225
Mailing Address - Fax:
Practice Address - Street 1:8027 LEESBURG PIKE
Practice Address - Street 2:SUITE 304
Practice Address - City:TYSONS
Practice Address - State:VA
Practice Address - Zip Code:22182-2701
Practice Address - Country:US
Practice Address - Phone:703-674-6225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005479103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty