Provider Demographics
NPI:1578656864
Name:NAFPAKTITIS, MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:NAFPAKTITIS
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 1:3040A BERKMAR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1444
Mailing Address - Country:US
Mailing Address - Phone:434-973-4503
Mailing Address - Fax:434-296-4867
Practice Address - Street 1:3040A BERKMAR DRIVE
Practice Address - Street 2:VILLAGE OFFICES
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1148
Practice Address - Country:US
Practice Address - Phone:434-973-4503
Practice Address - Fax:434-296-4867
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003672103TC0700X
CAPSY17171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190001496Medicare ID - Type Unspecified