Provider Demographics
NPI:1447070362
Name:BRAINWELLNESS NEUROPSYCHOLOGY SOLUTIONS, PLLC
Entity type:Organization
Organization Name:BRAINWELLNESS NEUROPSYCHOLOGY SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANISEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-962-4089
Mailing Address - Street 1:1655 FORT MYER DR STE 700
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-3199
Mailing Address - Country:US
Mailing Address - Phone:703-962-4089
Mailing Address - Fax:
Practice Address - Street 1:1655 FORT MYER DR STE 700
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-3199
Practice Address - Country:US
Practice Address - Phone:703-962-4089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty