| Organization Name: | JACK A MERENDA, PSY.D., INC. |
| NPI Number: | 1083006365 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACK ALLEN MERENDA (PRESIDENT) |
| Mailing Address: | 9306 Old Keene Mill Rd B Burke |
| State: | VA US |
| Postal Code: | 220154280 |
| Phone Number: | 7034748905 |
| Fax Number: | |
| NPI Enumeration Date: | 02/24/2015 |
| NPI Last Update Date: | 02/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 0810005120 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |