Provider Demographics
NPI:1053620575
Name:MATEUS, LOUIS PHILIPPE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:PHILIPPE
Last Name:MATEUS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S WHITING ST
Mailing Address - Street 2:501
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3656
Mailing Address - Country:US
Mailing Address - Phone:703-639-7714
Mailing Address - Fax:
Practice Address - Street 1:5500 HOLMES RUN PKWY
Practice Address - Street 2:C4
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2863
Practice Address - Country:US
Practice Address - Phone:703-379-7350
Practice Address - Fax:703-379-7352
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004214103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical