Provider Demographics
NPI:1043074222
Name:BEHAVIORAL HEALTH OF NORTHERN VIRGINIA
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH OF NORTHERN VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCHANDANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-306-1481
Mailing Address - Street 1:8300 ARLINGTON BLVD STE G1
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8300 ARLINGTON BLVD STE G1
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5209
Practice Address - Country:US
Practice Address - Phone:571-306-1481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Multi-Specialty