Provider Demographics
NPI:1932269339
Name:SMREKAR, MARY JO (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:SMREKAR
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 1:11231 HANDLEBAR RD
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3907
Mailing Address - Country:US
Mailing Address - Phone:703-391-1114
Mailing Address - Fax:703-391-7177
Practice Address - Street 1:11231 HANDLEBAR RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3907
Practice Address - Country:US
Practice Address - Phone:703-391-1114
Practice Address - Fax:703-391-7177
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001646103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical