Provider Demographics
NPI:1457407009
Name:WOODBRIDGE PSYCHOLOGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:WOODBRIDGE PSYCHOLOGICAL ASSOCIATES, P.C.
Other - Org Name:WPA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STEJSKAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-491-0042
Mailing Address - Street 1:2200 OPITZ BLVD STE 105B
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3342
Mailing Address - Country:US
Mailing Address - Phone:703-491-0042
Mailing Address - Fax:703-491-9200
Practice Address - Street 1:2200 OPITZ BLVD STE 105B
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3342
Practice Address - Country:US
Practice Address - Phone:703-491-0042
Practice Address - Fax:703-491-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810011635103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA145747OtherANTHEM BCBS