Provider Demographics
NPI:1184086779
Name:U.S.NAVY
Entity type:Organization
Organization Name:U.S.NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGY INTERN
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:757-953-6741
Mailing Address - Street 1:470 MIDDLE ST
Mailing Address - Street 2:APT 220
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:470 MIDDLE ST
Practice Address - Street 2:APT 220
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2813
Practice Address - Country:US
Practice Address - Phone:757-953-6741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital