Provider Demographics
NPI:1053100115
Name:BAHREMAND, POURYA (PHD)
Entity type:Individual
Prefix:
First Name:POURYA
Middle Name:
Last Name:BAHREMAND
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 TOWERS CRESCENT DR FL 13
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-6211
Mailing Address - Country:US
Mailing Address - Phone:301-905-2295
Mailing Address - Fax:
Practice Address - Street 1:8000 TOWERS CRESCENT DR FL 13
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-6211
Practice Address - Country:US
Practice Address - Phone:301-905-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008847103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical