Provider Demographics
NPI:1053790956
Name:DFAS-CL/JFLP
Entity type:Organization
Organization Name:DFAS-CL/JFLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGOT
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-442-3867
Mailing Address - Street 1:620 JOHN PAUL JONES CIR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:757-953-6744
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR BLDG 3
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-6744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005107286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810005107OtherTRICARE PRIME