Provider Demographics
NPI:1780785824
Name:REZNICK, HELEN W (PHD)
Entity type:Individual
Prefix:DR
First Name:HELEN
Middle Name:W
Last Name:REZNICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MARTHA CUSTIS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2000
Mailing Address - Country:US
Mailing Address - Phone:703-379-9520
Mailing Address - Fax:703-379-9529
Practice Address - Street 1:1225 MARTHA CUSTIS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2000
Practice Address - Country:US
Practice Address - Phone:703-379-9520
Practice Address - Fax:703-379-9529
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001878103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAR85219Medicare UPIN
00B335D70Medicare ID - Type UnspecifiedMEDICARE NUMBER