Provider Demographics
NPI:1760575765
Name:PERLSTROM, JAMES R (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:PERLSTROM
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 1:2235 CEDAR LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5247
Mailing Address - Country:US
Mailing Address - Phone:703-752-7881
Mailing Address - Fax:703-752-7880
Practice Address - Street 1:2235 CEDAR LN
Practice Address - Street 2:STE 202
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-5247
Practice Address - Country:US
Practice Address - Phone:703-752-7881
Practice Address - Fax:703-752-7880
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002163103T00000X, 173F00000X
MD03368103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No173F00000XOther Service ProvidersSleep Specialist, PhD
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00B727543Medicare ID - Type Unspecified