Provider Demographics
NPI:1679781736
Name:VANDENBOS, JANE ANNUNZIATA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ANNUNZIATA
Last Name:VANDENBOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:ANNUNZIATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1706 ESQUIRE LN
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4754
Mailing Address - Country:US
Mailing Address - Phone:703-734-1431
Mailing Address - Fax:703-356-3461
Practice Address - Street 1:6842 ELM ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3891
Practice Address - Country:US
Practice Address - Phone:703-827-8268
Practice Address - Fax:703-356-3461
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001397103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent