Provider Demographics
NPI:1295189835
Name:NEUROLOFT II LLC
Entity type:Organization
Organization Name:NEUROLOFT II LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOFTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-689-0003
Mailing Address - Street 1:11107 SUNSET HILLS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5376
Mailing Address - Country:US
Mailing Address - Phone:703-689-0003
Mailing Address - Fax:703-775-4944
Practice Address - Street 1:11107 SUNSET HILLS RD STE 110
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5376
Practice Address - Country:US
Practice Address - Phone:703-689-0003
Practice Address - Fax:703-775-4944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROLOFT HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003327225400000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty