DR. JACOB LEVI PRILUCK (NPI# 1992289425) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1992289425 |
Entity Type | Individual |
Full Name | DR. JACOB LEVI PRILUCK |
Credential | PSYD |
Practice Address |
6120 Brandon Ave Springfield VA 22150-2522 |
Mailing Address |
2311 Hanway Rd Baltimore MD 21209-2601 |
Practice Telephone | 9177830634 |
Mailing Telephone | 9177830634 |
Enumeration Date | 2018-09-20 |
Last Update Date | 2018-11-22 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 103G00000X | Clinical Neuropsychologist | 0810006056 | VA | Behavioral Health & Social Service Providers |
N | 103TC0700X |
Psychologist Specialization: Clinical |
0810006056 | VA | Behavioral Health & Social Service Providers |
Street Address |
6120 BRANDON AVE |
City | SPRINGFIELD |
State | VA |
Zip Code | 22150-2522 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1497753529 | Ginger F Beecher | Nurse Practitioner | 6120 Brandon Ave, Suite 308, Springfield, VA 22150-2522 | 2005-07-12 |
1265802912 | Ahmed Elghobashi | Dentist | 6120 Brandon Ave, Ste 214, Springfield, VA 22150-2522 | 2015-10-06 |
1306214580 | Quality Counseling Services | Marriage & Family Therapist | 6120 Brandon Ave, Suite 116, Springfield, VA 22150-2522 | 2015-09-04 |
1013260983 | Springfield Oral Surgery, PC | Dentist | 6120 Brandon Ave, Suite 301, Springfield, VA 22150-2522 | 2012-10-17 |
1528345964 | Kay Dreyer Watkins | Marriage & Family Therapist | 6120 Brandon Ave, Springfield, VA 22150-2522 | 2011-11-14 |
1962788190 | Sean Patrick Kelliher | Dentist | 6120 Brandon Ave, Suite 211, Springfield, VA 22150-2522 | 2011-11-02 |
1578844742 | Julie Anne Todd | Nurse Practitioner | 6120 Brandon Ave, Springfield, VA 22150-2522 | 2011-09-01 |
1376833525 | Brain Matters, Pllc | Clinic/Center | 6120 Brandon Ave, #315, Springfield, VA 22150-2522 | 2011-04-08 |
1861796294 | Deborah C Gale | Speech-Language Pathologist | 6120 Brandon Ave, #315, Springfield, VA 22150-2522 | 2010-12-28 |
1275837825 | Jeremiah Joseph Kelliher Jr. | Dentist | 6120 Brandon Ave, Suite 211, Springfield, VA 22150-2522 | 2010-12-22 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1083086946 | Karla Maria Bonilla Chico | Dentist | Privada Monte Everest 1982-14, Residencial La Cuspide, Tijuana, BAJA CALIFORNIA 22150 | 2015-10-30 |
1093108219 | Ezra Healthcare, Inc | Home Health | 6803 Backlick Road, Suit 'b', Springfield, VA 22150 | 2015-03-12 |
1144611567 | Grace Home Care, LLC | Home Health | 5827 Columbia Pike Suite 211, Springfield, VA 22150 | 2015-02-06 |
1174938245 | Rocio Robles | Speech-Language Pathologist | 7001 A Loisdale Road, Springfield, VA 22150 | 2014-06-26 |
1538598149 | Johns Hopkins Pharmaquip, Inc. | Durable Medical Equipment & Medical Supplies | 7411 Alban Station Court, Suite A100, Springfield, VA 22150 | 2013-11-04 |
1861785958 | Sienna Vorono Winer | Pediatrics | 6501 Loisdale Ct., Springfield, VA 22150 | 2011-05-23 |
1023342870 | M & T Universal Health Services, LLC | Home Health | 6315 Backlick Rd Ste 308, Springfield, VA 22150 | 2009-09-28 |
1316127533 | Yong Hyun Kim | Dentist | 6525-c Frontier Dr., Springfield, VA 22150 | 2007-11-05 |
1437234655 | Metropolitan Radiology Assoc Chtd | Radiology | 6128 Brandon Avenue, Suite 205, Springfield, VA 22150 | 2006-10-26 |
1033217179 | Allison Nayer | Occupational Therapist | The Chesapeake Center, Inc., 6506 Loisdale Rd., Suite 300, Springfield, VA 22150 | 2006-09-20 |
Find all providers in zip 22150 |
Taxonomy Code | 103G00000X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Clinical Neuropsychologist |
An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194850859 | Murrell Counseling Service, LLC | Clinical Neuropsychologist | 2200 E Sunshine St Ste 312, Springfield, MO 65804-1883 | 2007-02-22 |
1356424972 | Frederick A Ulam IIi | Clinical Neuropsychologist | 516 E Catalpa St, Springfield, MO 65807-1614 | 2006-10-24 |
1205864998 | Deborah A. Fein | Clinical Neuropsychologist | 155 Maple St, Suite 407, Springfield, MA 01105-1828 | 2006-06-29 |
1346294493 | Michelle Papka Puri | Clinical Neuropsychologist | 195 Mountain Ave, Springfield, NJ 07081-1755 | 2006-05-22 |
1306843735 | Michael Whetstone | Clinical Neuropsychologist | 2115 S Fremont Ave Ste 3000, Springfield, MO 65804-2215 | 2005-06-30 |
1437773454 | Alphonso Smith | Clinical Neuropsychologist | 319 E Madison St Fl 3, Springfield, IL 62701-1035 | 2020-06-05 |
1093349888 | Lindsay Nguyen Vo | Clinical Neuropsychologist | 1300 E Bradford Pkwy, Springfield, MO 65804-4264 | 2020-03-02 |
1295230431 | Jessica Di Marco | Clinical Neuropsychologist | 29 Ridgewood Rd, Springfield, VT 05156-3060 | 2018-03-29 |
1205355542 | Jessica Degaetano | Clinical Neuropsychologist | 195 Mountain Ave, Springfield, NJ 07081-1755 | 2017-09-19 |
1124566948 | Elizabeth Howell Mitchell Burns | Clinical Neuropsychologist | 3300 Main St, Springfield, MA 01107-1112 | 2017-02-01 |
Find all providers in SPRINGFIELD |
City | SPRINGFIELD |
Zip Code | 22150 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.