Provider Demographics
NPI:1356935597
Name:MCLEAN NEUROPSYCHIATRIC TREATMENT CENTER LLC
Entity type:Organization
Organization Name:MCLEAN NEUROPSYCHIATRIC TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AAZAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-663-1429
Mailing Address - Street 1:6849 OLD DOMINION DR STE 315
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3733
Mailing Address - Country:US
Mailing Address - Phone:571-378-1398
Mailing Address - Fax:571-580-0620
Practice Address - Street 1:6849 OLD DOMINION DR STE 315
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3733
Practice Address - Country:US
Practice Address - Phone:571-378-1398
Practice Address - Fax:571-580-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty