Provider Demographics
NPI:1689881062
Name:MICHAELSON, GEOFFREY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:
Last Name:MICHAELSON
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 1:1950 HOPEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1870
Mailing Address - Country:US
Mailing Address - Phone:703-534-5424
Mailing Address - Fax:
Practice Address - Street 1:2110 GALLOWS RD # A
Practice Address - Street 2:SUITE 100
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3962
Practice Address - Country:US
Practice Address - Phone:703-883-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001350103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X
DCPSY1574103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA602893Medicare ID - Type Unspecified