Provider Demographics
NPI:1538314034
Name:LANDOLF, BERNADETTE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:M
Last Name:LANDOLF
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 1:12007 SUNRISE VALLEY DR
Mailing Address - Street 2:STE 220
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3446
Mailing Address - Country:US
Mailing Address - Phone:703-860-2010
Mailing Address - Fax:703-860-2016
Practice Address - Street 1:12007 SUNRISE VALLEY DR
Practice Address - Street 2:STE 220
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3446
Practice Address - Country:US
Practice Address - Phone:703-860-2010
Practice Address - Fax:703-860-2016
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical