Basic Information
| Provider Information | |||||||||
| NPI: | 1669709036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYNAPSE ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 374 | ||||||||
| Address2: | |||||||||
| City: | PURCELLVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201340374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408829080 | ||||||||
| FaxNumber: | 5408829310 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 LOUDOUN ST SE | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201753115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408829080 | ||||||||
| FaxNumber: | 5408829310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2009 | ||||||||
| LastUpdateDate: | 11/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | RONDEAU | ||||||||
| AuthorizedOfficialFirstName: | HOLIDAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5408829080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.