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JACK MERENDA PSYD
NPI 1174366330
Psychologist - Clinical in Fairfax, VA

Active since June 17, 2024Opted out of Medicare · through Jun 21, 2028
3921 BLENHEIM BLVD, FAIRFAX, VA 22030(703) 474-8905 Get Directions Write a Review

NPPES record last updated: June 17, 2024. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Jack Merenda Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK MERENDA PSYD (NPI 1174366330) is an individual clinical provider in Fairfax, Virginia, licensed in Virginia (0810005120) and active in the NPI registry since June 2024. He has opted out of Medicare through June 21, 2028.

NPPES Registry Identity

NPI1174366330
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NameJACK MERENDACredential: PSYD
Location Address3921 BLENHEIM BLVDFairfax, VA 22030-2429
Mailing Address9306 Old Keene Mill Rd Ste BBurke, VA 22015-4280 · (703) 474-8905
Phone(703) 474-8905
Sole ProprietorNo
Enumeration DateJune 17, 2024
NPPES CertifiedJune 16, 2024
✔ NPI 1174366330 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in VA · 0810005120
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
3921 BLENHEIM BLVD, Fairfax, VA 22030
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Jack Merenda Psyd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from June 21, 2024 through June 21, 2028.

Opt-Out Effective DateJune 21, 2024
Opt-Out In Effect ThroughJune 21, 2028Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Merenda's NPI number?

The NPI number for Jack Merenda is 1174366330. It was assigned to this individual provider in the NPPES registry on June 17, 2024.

Where is Jack Merenda located?

Jack Merenda practices at 3921 Blenheim Blvd, Fairfax, VA 22030. The listed phone number is (703) 474-8905.

What is Jack Merenda's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Jack Merenda enrolled in Medicare?

No. Jack Merenda has opted out of Medicare through June 21, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Jack Merenda was last updated on June 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.